Percutaneous Valve Repair and Replacement

Abstract

This issue of Circulation contains reports on the acute results of 2 approaches for percutaneous heart valve treatment.1,2 The introduction of nonsurgical, catheter-based approaches to the management of valvular heart disease is in a phase of rapid development. These 2 reports highlight both challenges and successes in phase I experience with these innovative therapies. Articles pp 842 and 851 Percutaneous valve therapy developed initially with aortic valve replacement, described by Andersen et al3 in 1992 in a swine model. These investigators fabricated a stent-mounted bioprosthetic valve and demonstrated that percutaneous implantation is feasible. Bonhoeffer et al4 reported the use of a stent-mounted bioprosthesis for pulmonic valve replacement in 2000. This achievement clearly marked the beginning of the era of percutaneous valve replacement therapy in patients. Pulmonic valve replacement with this percutaneous approach has been remarkably successful. To date, >100 patients have been treated, with only a single procedure-related mortality and good results in a population of pediatric patients with congenital heart disease who otherwise would face third or fourth open heart procedures. Percutaneous aortic valve replacement with a stent-mounted bioprosthetic valve device was initially reported by Cribier et al5,6 in 2002, with a growing experience since then. Numerous technical and clinical challenges have been encountered during phase I procedures for percutaneous heart valve therapy. The patient population for aortic valve replacement has been a group of patients considered high risk for surgery or nonsurgical candidates with numerous comorbid conditions. These patients have come to the cardiac catheterization laboratory with hypotension and low cardiac output. Under the best circumstances, they represent a great management challenge, even without the demands of new, complex percutaneous procedures. Early mortality in this group has been high, but there have also been stunning successes. Percutaneous aortic valve replacement was initially accomplished by …