Abstract
During the last years, the numbers of interventions in structural heart disease such as transcatheter aortic valve implantation (TAVI), percutaneous treatment of mitral regurgitation using the MitraClip, closure of atrial septal defects (ASD) and others have constantly increased. While the 20th century was called the century of surgery, it appears that the present century might be the century of minimally invasive percutaneous therapy. The reduced invasiveness of these procedures and the success in elderly patients make these treatments increasingly attractive for younger and healthier patients. Now that these procedures are moving forward, some questions arise, namely, who is deciding on treatment modality, and can we afford it?
Highlights
Structural heart disease consists of congenital conditions such as complex congenital heart disease, patent foramen ovale (PFO), atrial septal defects (ASD), ventricular septal defects (VSD), and hypertrophic obstructive cardiomyopathy (HOCM), and conditions which are acquired during life such as dysfunctions of the native aortic and mitral valves and paravalvular leaks following valve replacement
A special entity is the left atrial appendage, which is a normal cardiac structure; since it may be the source of emboli in atrial fibrillation, it represents a possible target for interventional treatment
incremental cost-effectiveness ratios (ICER) are defined as the difference in costs between two therapies divided by the difference in QALYs and are expressed as a certain sum per quality of lifeadjusted life years gained (QUALY) which is the value of a therapy in comparison to another
Summary
The numbers of interventions in structural heart disease such as transcatheter aortic valve implantation (TAVI), percutaneous treatment of mitral regurgitation using the MitraClip, closure of atrial septal defects (ASD) and others have constantly increased. While the 20th century was called the century of surgery, it appears that the present century might be the century of minimally invasive percutaneous therapy. The reduced invasiveness of these procedures and the success in elderly patients make these treatments increasingly attractive for younger and healthier patients. That these procedures are moving forward, some questions arise, namely, who is deciding on treatment modality, and can we afford it?
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