Percutaneous cardiac interventions were introduced in the 1960s, and, with the introduction of percutaneous coronary interventions by Gruentzig in 1978, the field has had an astounding growth. Percutaneous coronary intervention (PCI) is the most commonly preformed revascularization technique in the United States today with an estimated 492 000 procedures done in 20101 (Figure 1). This exceeds the number of coronary bypass operations estimated to be 397 000. Likewise, the growth of structural heart disease, in particular, valvular heart disease, has been remarkable with >10 000 procedures in 2013 in the United States 2 years after approval and 38 000 over the first 5 years of approval in Europe.2 It is estimated that > 200 000 transcatheter aortic valve replacement (TAVR) procedures have been done worldwide to date. Growth in TAVR has increased the volume of surgical aortic valve replacement as well3 (Figure 2). Invasive pediatric interventions have accelerated over the past decade with better devices and improved success. Peripheral vascular interventions have also grown, expanding into venous in addition to arterial interventions. The field of interventional cardiology is now much broader and more complex than ever before and specialization within interventional cardiology is increasing.4 This review will discuss 2 areas where change has been most dramatic: coronary and valvular interventions. Figure 1. Trends in cardiovascular procedures, United States: 1979 to 2010; inpatient procedures only.1 PCI indicates percutaneous coronary intervention. Original Source: National Hospital Discharge Survey, National Center for Health Statistics, and National Heart, Lung, and Blood Institute. Figure 2. Growth of TAVR in Germany 2007 to 2013.3 Number of transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR) procedures performed, according to type of procedure and age group, 2007 to 2013. TA indicates transapical; and TF, transfemoral. ### The Current Status of Coronary Interventions Studies over the past decade have shown that the procedure is effective in relieving …