Catheter-based techniques have revolutionized the treatment of structural heart diseases, providing less invasive alternatives to traditional open-heart surgery. Several novel devices have been developed to address a wide spectrum of structural cardiac pathologies.
Transcatheter mitral valvuloplasty
Mitral valve stenosis, which is most commonly diagnosed in individuals with a history of rheumatic fever, is often not managed surgically. Balloon dilation is possible using the established Inoue technique, and the method is recommended as the treatment of choice by both the European and American Heart Associations). Compared with cardiac surgery, the procedure carries significantly lower morbidity and risk of complications.
Transcatheter Closure of Patent Foramen Ovale and Atrial Septal Defects
Many cases of atrial septal defect (ASD) and patent foramen ovale (PFO) can now be treated percutaneously by interventional cardiologists using dedicated closure devices, thus avoiding open-heart surgery. The procedure typically requires only a single day of hospitalization, and when performed in experienced centers, the risk of complications is minimal.
Transcatheter Aortic Valve Replacement (TAVR)
Transcatheter aortic valve replacement (TAVR) is a minimally invasive procedure used to replace the aortic valve in patients with severe aortic stenosis who are at high or prohibitive surgical risk. Advances in valve design, delivery systems, and imaging guidance have expanded patient eligibility and improved procedural and clinical outcomes.
It has now been demonstrated that TAVR can also be performed in younger, lower-risk patients. Furthermore, TAVR is indicated in patients with degeneration of a previously implanted bioprosthetic aortic valve—a scenario typically observed approximately ten years after the initial surgery—when the risk of redo open-heart surgery is deemed high.
In such cases, valve-in-valve TAVR offers a highly beneficial therapeutic option. The decision between surgical and transcatheter valve replacement should always be individualized, taking into account the patient’s specific clinical profile, comorbidities, and anatomical characteristics. Procedural risks are comparable to those of cardiac surgery but with substantially reduced perioperative burden and recovery time for the patient.
Transcatheter Mitral and Tricuspid Valve Repair and Replacement
A variety of devices now allow for the transcatheter repair of the mitral (e.g., MitraClip, PASCAL, Cardioband) and tricuspid (e.g., TriClip, Triluminate Pivotal) valves in patients with severe regurgitation who are not suitable candidates for surgery.
This technique has demonstrated significant clinical benefits, including symptomatic improvement and enhanced survival rates.
Moreover, transcatheter mitral and tricuspid valve replacement procedures have become feasible, offering effective treatment options while avoiding open-heart surgery altogether.
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