Traditional Surgical Intervention Research Articles

Anaesthesia management of interventional cardiac catheterisation for pulmonary atresia with intact ventricular septum and critical pulmonary stenosis: a retrospective analysis.

Pulmonary atresia with intact ventricular septum and critical pulmonary stenosis usually have to undergo treatment in the neonatal period. Compared to traditional surgical intervention, catheter-based cardiac interventions may achieve similar or superior outcomes for neonates with pulmonary atresia with intact ventricular septum and critical pulmonary stenosis. However, there is limited literature on anaesthesia techniques, challenges, and risks associated with cardiac catheterisation in this population. This article retrospectively analysed the clinical data of pulmonary atresia with intact ventricular septum and critical pulmonary stenosis neonates who were treated with interventional cardiac catheterisation in our hospital from January 2015 to October 2022. Clinical outcomes considered were haemodynamic or pulse oxygen saturation instability, vasoactive requirements, prolonged intubation (>24 h postoperatively), and cardiovascular adverse events. A total of 63 patients met the inclusion criteria. All patients survived the intervention. Among the patients with critical pulmonary stenosis, 40 successfully received percutaneous balloon pulmonary valvuloplasty, while three patients received ductal stenting due to moderate right ventricular dysplasia at the same time. For patients with pulmonary atresia with intact ventricular septum, 17 of the 23 patients successfully underwent percutaneous pulmonary valve perforation and percutaneous balloon pulmonary valvuloplasty. Of these, five patients underwent ductal stenting due to unstable pulmonary blood flow. Three patients only underwent ductal stenting. In addition, three patients received hybrid therapy. There are various clinical techniques and risk challenges in the interventional cardiac catheterisation of neonatal pulmonary atresia with intact ventricular septum and critical pulmonary stenosis. However, by mastering the physiological and pathophysiological characteristics of the disease, adequately preparing for the perioperative period, and predicting the procedure process and potential complications, anaesthesia and surgical risks can be effectively managed.

Comparison of laser ablation and Karidakis surgery for treating epithelial coccygeal passages

BACKGROUND: Laser ablation is a technique which was originally used to treat various cystic and fistulous structures. Due to promising results, surgeons began to use diode lasers to treat pilonidal cysts. The authors developed their own technique of ultrasonic-guided laser ablation in patients with the discussed pathology. AIM: To compare outcomes after laser ablation and Karidakis surgery for treating pilonidal cysts. METHODS: A prospective non-randomized comparative study was performed. Outcomes of surgical interventions were analyzed in 71 patient with pilonidal disease: 24 patients were operated with laser obliteration technique and 47 — with Karidakis technique. The researchers compared: time of wound healing and number of recurrences, complications, length of hospital stay and duration of postoperative pain. RESULTS: Mean operative time in the laser group was 26.45±5.41 min (20–35 min), while in the Karidakis group — 58.63±7.42 min (50–75 min). In the laser group, primary healing was registered in 23 out of 24 patients (95.8%) with an overall complication rate 20.83%. In each group, there were registered two cases with relapses after discharge. The obtained clinical results, in general, were comparable to those in the world literature. However, the quality of life of patients after laser treatment was significantly better than after traditional surgical intervention which is confirmed by less hospital stay up to 5–7 bed-days; by less surgical time, in average, 25 minutes; faster recovery — within one week after surgery; faster return to everyday life, as well as less pain syndrome in the postoperative period. CONCLUSION: Laser ablation of the coccygeal tract is comparable to Karidakis surgery in terms of wound healing and recurrences, but it gives better results in terms of surgical time, hospital stay and postoperative pain.

Unusual application of topical brimonidine for the management of epithelial cysts

The mainstay management of progressive epithelial cysts spans from fine-needle aspiration of the cyst content to radical en bloc excision. Such a surgical approach may result in cyst rupture, recurrence, or collateral tissue damage. Based on previous experience, we aimed at evaluating the off-label use of topical brimonidine as a conservative measure for treating epithelial cysts of the iris and conjunctiva before commencing a surgical excision. We describe two different cases of epithelial cysts in which topical brimonidine was issued with successful outcome, making the more traditional surgical intervention redundant.

Endoscopic Vacuum Therapy for iatrogenic esophageal perforation in a child

Esophageal perforation (EP) has historically been a devastating condition resulting in high morbidity and mortality. The use of endoluminal therapies to treat esophageal leaks and perforations has grown exponentially over the last decade and offers many advantages over traditional surgical intervention in the appropriate circumstances. Here, we present a case of iatrogenic perforation of esophagus successfully treated with Endoscopic Vacuum Therapy (EVT) in a 6-year-old female patient.

Trocar Puncture With a Sump Drain for Crohn's Disease With Intra-Abdominal Abscess: A 10-Year Retrospective Cohort Study

BackgroundTraditional percutaneous catheter drainage (PCD) and surgical intervention could not always achieve satisfactory results for patients with Crohn's disease (CD) who have complications with intra-abdominal abscess. We proposed a trocar puncture with sump drainage for the treatment of CD with intra-abdominal abscess and compared it with the conventional PCD and surgical intervention.MethodsCrohn's disease patients with intra-abdominal abscess and admitted to our hospital from 2011 to 2020 were identified by reviewing the electronic medical records. We divided them into Trocar, PCD, and fecal diverting (FD) groups, according to the ways of treating an abscess. Outcomes, risk factors for abscess recurrence, and postoperative complications were compared among the three groups.ResultsA total of 69 patients were included and they were divided into Trocar (n = 18), PCD (n = 29), and FD (n = 22) groups. Four patients in the PCD group were transferred to receive the FD surgery due to the failure of initial treatment. The incidence of abscess recurrence was significantly higher in the PCD (48%) and FD (50%) groups compared to the patients using the trocar puncture with the sump drain (Trocar group) (16.7%). There were 8 patients in Trocar, 22 in PCD, and 20 s in the FD group who received enterectomy. None of the patients in the Trocar had an ultimate stoma and the incidence of postoperative complications was statistically lower [0% (Trocar) vs. 31.8% (PCD) vs. 45% (FD), P < 0.05]. The way of initial treating of the abscess was significantly correlated with the abscess recurrence and postoperative complications.ConclusionsTrocar puncture with a sump drain had a lower incidence of abscess recurrence, abdominal adhesions, postdrainage, and postoperative complications compared to the conventional PCD or surgical intervention.

Paradigm Shift in the Management of Pseudoaneurysm Following Nephrolithotomy-A Case Series

Renal artery pseudoaneurysm after nephrolithotomy or pyelolithotomy is rare, but is more often following Percutaneous Nephrolithotomy (PCNL) or renal biopsy. It is a potentially life-threatening condition, with an incidence of 0.1 to 0.3% after nephrolithotomy or pyelolithotomy. Manifestation may vary, from asymptomatic to symptoms like local bloody discharge, haematuria, pain, high blood pressure, and rupture causing a life-threatening condition. A minimally invasive technique, selective or super-selective angioembolisation is the treatment of choice. This case series reports, five cases presented with either bloody wound discharge or intermittent haematuria in the emergency department, post nephrolithotomy. All patients were resuscitated in the emergency department with intravenous fluid and packed red blood cell transfusion. After resuscitation, three patients were diagnosed with renal artery pseudoaneurysm on Computed Tomography of Kidneys, Ureters and Bladder (CT KUB) and angiography, and two patients with digital subtraction angiography during the intervention. All were treated with super-selective renal artery angioembolisation, with endovascular coiling of different sizes. All patients made an uneventful recovery, and on followup no complication was evident. Now-a-days the popularity of angioembolisation for renal artery pseudoaneurysm has increased, which shows a paradigm shift from a traditional surgical intervention.

About the Phenomenon of Iatrogenic Endocrine Disruption in the Female Pig’s Reproductive Endocrine System

Endocrine disruptors have been present in our environment since the tide of stable, man-made chemicals of the Industrial Age arose. As it has turned out, one of the medicaments used in my studies, diethylstilboestrol (DES), is also a very potent endocrine disruptor. These field trials took place a long time ago, in the 1960s, when the use of this kind of treatment was still authorized in the veterinary medical practice in order to hormonally castrate fattening female pigs instead of the traditional surgical intervention. Diethylstilboestrol (DES) was then suggested to be administered to pigs for this purpose. However, now DES must not be administered to food animals at all. The result of the hormonal treatment of pigs was then believed to be a consequence of a negative feedback reaction. Nevertheless, thorough investigations found that the induced reaction was not a negative, but on the contrary, a positive feedback reaction. In the meantime it came to light that the medicament DES itself is a most potent endocrine disruptor. Later it became clear that this positive feedback reaction could be regarded as the manifestation of the significant protective effect of the corpus luteum function, the organism’s own, natural shield aimed at preventing certain disrupting factors. This seems to be a promising domain worthy of doing research on.

Adjunct procedures for malperfusion syndrome in complicated acute type B aortic dissection

: Acute aortic dissection is a common and often fatal aortic emergency. Treatment of type Baortic dissection typically consists of medical therapy in the uncomplicated cases, with surgical therapy reserved for complicated aortic dissection. Surgical therapy has shifted from traditional open surgical intervention to less invasive endovascular surgical interventions as a first line option. Complicated aortic dissection often presents as visceral or lower limb malperfusion (LLM). Conventional therapy of complicated aortic dissection has been revascularization of the affected vascular bed. Recently, numerous clinical trials and retrospective series have shown that treatment of the proximal aortic entry tear combined with targeted revascularization of the ischemic vascular bed leads to improved short term and long-term patient outcomes. This article outlines the interventional approach to the patient with complicated aortic dissection.

Single-Vessel Branched Endovascular Repair of an Enlarging Aortic Arch Pseudoaneurysm

Aortic arch pseudoaneurysm is a rare, but serious, complication of aortic dissection with a high risk of rupture. Traditional open surgical intervention has been associated with a high mortality rate (7%-17%). Thoracic endovascular aortic repair (TEVAR) provides a minimally invasive option but requires a 2-cm proximal seal. Advances in device development have led to an increasing body of experience with branched TEVAR (B-TEVAR). These new devices provide a minimally invasive alternative for patients with various types of aortic disease and preserve perfusion to supra-aortic arch vessels.

2D MOF Periodontitis Photodynamic Ion Therapy.

Traditional surgical intervention and antibiotic treatment are poor and even invalid for chronic diseases including periodontitis induced by diverse oral pathogens, which often causes progressive destruction of tissues, even tooth loss, and systemic diseases. Herein, an ointment comprising atomic-layer Fe2O3-modified two-dimensional porphyrinic metal-organic framework (2D MOF) nanosheets is designed by incorporating a polyethylene glycol matrix. After the atomic layer deposition surface engineering, the enhanced photocatalytic activity of the 2D MOF heterointerface results from lower adsorption energy and more charge transfer amounts due to the synergistic effect of metal-linker bridging units, abundant active sites, and an excellent light-harvesting network. This biocompatible and biodegradable 2D MOF-based heterostructure exhibits broad-spectrum antimicrobial activity (99.87 ± 0.09%, 99.57 ± 0.21%, and 99.03 ± 0.24%) against diverse oral pathogens (Porphyromonas gingivalis, Fusobacterium nucleatum, and Staphylococcus aureus) by the synergistic effect of reactive oxygen species and released ions. This photodynamic ion therapy exhibits a superior therapeutic effect to the reported clinical periodontitis treatment owing to rapid antibacterial activity, alleviative inflammation, and improved angiogenesis.

Stand-Alone Middle Meningeal Artery Embolization for Treatment of Giant Chronic Subdural Hematoma in Elderly Frail Patients: A Case Series

ABSTRACT BACKGROUND Previous case series have demonstrated safety and efficacy of middle meningeal artery (MMA) embolization as both adjuvant and stand-alone treatment of chronic subdural hematoma (cSDH). The safety and efficacy of stand-alone MMA embolization for treatment of giant (&gt;150 ml) cSDH in specifically elderly, frail patients is not well studied. OBJECTIVE To evaluate the safety and efficacy of stand-alone MMA embolization for treatment of giant cSDH in elderly, frail patients in whom traditional surgical intervention was deemed high risk. METHODS We reviewed the records of consecutive patients referred for MMA embolization and identified patients ≥ 75 yr with modified Frailty Index (mFI) ≥ 2 who underwent stand-alone MMA embolization for cSDH treatment with at least one follow-up imaging study. RESULTS A total of 42 patients were referred for MMA embolization with 5 patients meeting inclusion age and frailty criteria. The average age was 82.2 ± 6.8 yr. The median mFI was 3.0 (interquartile range (IQR) 2-4). Four patients were either on aspirin or thrombocytopenic. The average initial cSDH volume was 187.8 ± 31 ml with average initial midline shift of 8.0 ± 2.1 mm. The average length of stay was 4 ± 1.1 d. The average cSDH volume decrease on follow-up imaging was 68.5% ± 11.9%. Follow-up average midline shift decreased by 70% to 2.4 ± 1.4 mm. There were no peri-procedural or in-hospital complications. CONCLUSION In frail, elderly patients with giant cSDH, stand-alone MMA embolization was effective in reducing cSDH volume and improving presenting symptoms without complications.

Lessons for Emergency Surgery in the Second Wave: One-Month Single-Centre Experience During the First Wave of COVID-19.

IntroductionThe global COVID-19 pandemic had a deleterious effect upon elective and emergency surgery. Focus of patient care was directed to emergency services. Association of Surgeons of Great Britain and Northern Ireland guidelines advised a trend towards conservative management. Traditional surgical intervention was reserved only for selected cases only. We evaluated our emergency practice over a four-week period during the first peak of COVID-19.MethodsA retrospective single-centre analysis was performed of consecutive patients seen by the emergency general and vascular surgery on-call team in a District General Hospital over a four-week period (30 March 2020-26 April 2020). Primary outcome was 30-day COVID-19 mortality. Secondary outcomes were 30-day complications, readmission rate and non-COVID-19-related mortality. Adherence to intercollegiate guidelines was also assessed. ResultsA total of 184 patients were assessed during the period. The median age was 55 years (interquartile range 34-75), with a male:female ratio of 1:0.7. Thirty-day COVID-19- and non-COVID-19-related mortalities were 3% and 8%, respectively. Thirteen percent of patients developed complications and 9% represented to the emergency department within 30 days. Conservative management was initially employed in 78% of patients. This had success rates in appendicitis and cholecystitis of 72% and 75%, respectively. A CT thorax was included in 89% having a CT abdomen and pelvis. Thirty-eight percent had a COVID-19 polymerase chain reaction (PCR) swab test performed throughout the study period. Fifty-two percent of individuals who underwent emergency surgery had a swab performed prior to operative intervention.ConclusionsConservative management seems to be reasonably effective and may re-shape the way we treat a proportion of surgical pathologies in the future. Further long-term data are required in order to evaluate this. A paucity of PCR testing was due to nationwide capacity shortcomings. This must be addressed in future peaks with rapid testing in order to triage patients to the appropriate setting.

CHANGES IN BIOCHEMICAL BLOOD VALUES DURING COMPLEX TREATMENT OF RHINOSINUSITIS POLYPOSA PATIENTS

The aim: To increase the effectiveness of treatment of sinusitis polyposa patients, develop and introduce a new non-traditional complex method of influencing several links of the pathogenesis of this disease, including laser therapy and laser puncture, used in the postoperative period. Materials and methods: In 60 rhinosinusitis polyposa patients the indicators of lipid peroxidation and the state of antioxidant protection were studied. Depending on the type of treatment, the patients were divided into two groups: the first included 30 people who underwent traditional surgical intervention, and the second - 30 people who used complex therapy, including in the postoperative period endonasal laser exposure and laser puncture. Methods: clinical data, the functional state of the nasal mucosa, indicators of lipid peroxidation (hydroperoxide, malondialdehyde) and antioxidant activity (glutathione peroxidase, glutathione reductase, reduced glutathione, superoxide cismutase, catalase) of erythrocyte membranes and blood serum were studied. Results: The proposed complex method for treating lipids of erythrocyte membranes and serum, which includes endonasal surgical intervention, endonasal laser therapy and laser puncture leads to the normalization of physiological functions of the nose, activates antioxidant protection and reduces the peroxide activity of lipids in the membranes of erythrocytes and blood serum. Conclusions: When examining patients in the long-term (after 1 year) period, a significant improvement in 85.7% of cases, an improvement in 10.7%, and absence of effect in 3.6% was achieved. Thus, the proposed method of therapy can be recommended for widespread use in medical institutions.

Bifunctional, Copper-Doped, Mesoporous Silica Nanosphere-Modified, Bioceramic Scaffolds for Bone Tumor Therapy

In the traditional surgical intervention procedure, residual tumor cells may potentially cause tumor recurrence. In addition, large bone defects caused by surgery are difficult to self-repair. Thus, it is necessary to design a bioactive scaffold that can not only kill residual tumor cells but also promote bone defect regeneration simultaneously. Here, we successfully developed Cu-containing mesoporous silica nanosphere-modified β-tricalcium phosphate (Cu-MSN-TCP) scaffolds, with uniform and dense nanolayers with spherical morphology via 3D printing and spin coating. The scaffolds exhibited coating time- and laser power density-dependent photothermal performance, which favored the effective killing of tumor cells under near-infrared laser irradiation. Furthermore, the prepared scaffolds favored the proliferation and attachment of rabbit bone marrow-derived mesenchymal stem cells and stimulated the gene expression of osteogenic markers. Overall, Cu-MSN-TCP scaffolds can be considered for complete eradication of residual bone tumor cells and simultaneous healing of large bone defects, which may provide a novel and effective strategy for bone tumor therapy. In the future, such Cu-MSN-TCP scaffolds may function as carriers of anti-cancer drugs or immune checkpoint inhibitors in chemo-/photothermal or immune-/photothermal therapy of bone tumors, favoring for effective treatment.

Endoluminal wound vac: an evolving role in treatment of esophageal perforation

: The treatment of esophageal leaks and perforations has evolved over time with the advancement of technology. Compared to traditional surgical intervention, newer less invasive options such as stents can be effective with less morbidity. The latest addition to the surgeon’s armamentarium, endoluminal wound vac therapy (EVT), uses the principle of negative pressure wound therapy to heal leaks and perforations.

Желудочно-кишечные кровотечения у больных в остром периоде инфаркта миокарда: обзор литературы

Currently, diseases of the circulatory system are the leading cause of death. A particular problem of a modern multidisciplinary hospital is the combination of acute coronary syndrome (ACS) with gastrointestinal bleeding (GIB), since it is characterized by a syndrome of mutual burdening and mutually exclusive approaches to treatment. The development of GIB in patients with ACS increases the mortality rate of patients to 50-80%. Despite the practical importance of this problem, today there are no clear recommendations and uniform principles for managing patients with such a unique scenario. The review describes in detail the reasons for the development of GIB in patients with ACS, discusses the mechanisms of action of drugs used in ACS and their importance in the development of GIB. It was found that the incidence of GIB in patients undergoing percutaneous coronary interventions reaches 4%, and the risk of re-bleeding doubles. The options for the treatment of GIB are considered: the role of endoscopic and drug hemostasis, as well as X-ray endovascular embolization of the gastric arteries, is shown as a minimally invasive alternative to traditional surgical intervention. Indications for discotinuation of dual antiplatelet therapy based on an objective assessment of the severity of bleeding have been formulated. Much attention is paid to the issue of prevention of GIB in patients with ACS. Risk factors for hemorrhagic complications were considered, and the risk assessment of possible GIB using the BARC scale was shown.

Experience of the laparoscopic-assisted stoma creation use in patients with colorectal cancer

Aim. To demonstrate the advantages of laparoscopic surgery in patients with colorectal cancer compared to traditional surgical intervention.&#x0D; Methods. A retrospective analysis of 40 patients treatment (the main group) in the Department of abdominal Oncology of the Kursk Regional Oncology Center for the period 20172019, who had a pronounced violation of the passage through the intestine due to stenosing by the tumour, was conducted. As a control group, 30 people who underwent open surgery in the volume of a colostomy for the period 20172019 was taken.&#x0D; Results. According to the average duration of surgical intervention, the groups significantly differed (p 0.05), the average duration of surgery in the laparoscopic group was less 40.513.6 min, with laparotomy 54.518.5 min. The volume of blood loss during the operation was greater in the control group and reached 7540 ml against, 10.55.5 ml the differences were statistically significant (p 0.05). The average length of stay in hospital in the laparoscopic group was 41 days, which is significantly less than in patients who underwent laparotomy 114 days (p 0.05). Postoperative complications occurred in 10% of patients in the control group: seroma of the median wound in 2 patients, ligature fistula in 1 patient. There were no postoperative fatalities in both groups.&#x0D; Conclusion. The comparison of methods of surgical intervention showed that the results of laparoscopic operations are much better than traditional open operations in patients with colorectal cancer since they significantly reduce the duration of the rehabilitation period, accompanied by minor blood loss.

THE RESULT OF LAPAROSCOPIC AND LAPAROTOMIC TREATMENT OF PATIENTS WITH EXTERNAL GENITAL ENDOMETRIOSIS USING IMMUNE RESPONSE MODIFIER

The objective of the work was to make a comparative analysis of the result of external genital endometriosis treatment with the use of traditional surgical intervention and hormone therapy together with the use of low-molecular-weight metabolic immune response modifier 5-amino-1,2,3,4-tetrahydrophthalazine-1,4-dione of sodium salt. Materials and methods: the experimental part of the study was previously conducted on 50 female rats which consisted of studying the influence of the immune response modifier on the course of experimentally induced endometriosis in experimental animals, in particular on changes in the estrous cycle. Injection of the immune response modifier caused retrogression of endometrioid heterotopias and normalization of the estrous cycle in the animals. The comparative analysis of the results of external genital endometriosis treatment in 66 women was conducted on the basis of experimental research. 34 women, apart from surgical intervention and hormone therapy, were injected with the immune response modifier 5-amino-1,2,3,4-tetrahydrophthalazine-1,4-dione of sodium salt during the post surgical period. Cellular immunity, T- and B-lymphocytes, and equipment and instrumental methods, such as medical ultrasound of the organs of the lower pelvis and laparoscopy, were used to assess the results of treatment. As a result of the treatment with the use of the immune response modifier the indicators of cells immunity changed, pain severity decreased, menstrual function normalized, relapse frequency reduced, and the overall quality of life for patients improved. Socially significant effect of treatment of external genital endometriosis using metabolic immune response modifier is manifested in implementation of reproductive function ‒ elimination of infertility in 50 % of women during the first year of observation.

A Single Center Retrospective Evaluation of a Surgical Strategy to Combat Persistent Soft Tissue Wounds Utilizing Absorbable Antibiotic Beads.

Objective: To determine whether use of absorbable antibiotic-imbued beads in chronic soft tissue wounds presents a viable therapeutic modality. Approach: Retrospective analysis of all cases utilizing calcium sulfate antibiotic beads was conducted. Cases comprised complex wound and breast reconstruction performed by the senior author (C.P.D.) over 4 years at the University of New Mexico Hospital. All-cause need for reoperation and reoperation for infection in the 90 days following bead-assisted surgery were compared to traditional surgical intervention in the 90-day period preceding bead-assisted surgery. Paired-samples t-test and corrected Cohen's d were calculated for outcome significance and effect size. Results: A total of 60 patients underwent 84 bead-assisted surgeries. There was a significant decrease in rate of reoperation following bead surgery (M = 0.32) compared with prebead surgery (M = 2.2), p < 0.001. Rate of reoperation for infection significantly decreased from 1.7 before bead surgery to 0.05 following bead surgery, p < 0.001. Results remained significant when stratified by complex wound or breast reconstruction, p < 0.01. Cohen's d ranged from 1.25 to 2.13, with probability of superiority between 80% and 93%. Innovation: Use of antibiotic-laden materials is well established in the orthopedic literature, but poorly characterized in soft tissue applications. Biofilms are increasingly implicated as a unifying pathologic foe underlying chronic wound infection and nonhealing. Antibiotic beads have demonstrated activity against biofilm in vitro. This study demonstrates diminished reoperative burden for these wounds following antibiotic bead surgery, possibly as a result of in vivo biofilm antagonism. Conclusion: Antibiotic bead-assisted surgery was associated with significantly decreased infectious and all-cause reoperations for chronic and infected wounds.

Complexities of transcatheter mitral valve replacement (TMVR) and why it is not transcatheter aortic valve replacement (TAVR).

Transcatheter mitral valve replacement (TMVR) is currently being investigated as a procedural alternative to surgical mitral valve repair or replacement (SMVR). Early data from first-in-man trials with current devices suggest that TMVR is technically feasible but carries a high mortality. This is substantially different from the early success transcatheter aortic valve replacement (TAVR) has seen and is related to complexities of the mitral valve anatomy, differences in pathology that require mitral valve replacement as well as the impact that mitral valve replacement has on physiology and cardiac function, irrespective of the modality by which the mitral valve is replaced. Importantly, in the case of TAVR, a less invasive method is offered to accomplish the same as the traditional surgical intervention. On the other hand, valve replacement is not the recommended treatment option for the majority of mitral valve disease, and in fact is avoided whenever possible during surgery given the shortened life expectancy and increased morbidity with mitral valve replacement. Another distinction between TAVR and TMVR is the etiology and natural progression of the underlying disease and driving factors for intervention that are vastly different between aortic and mitral valve disease. The primary aortic disease treated has been aortic stenosis, which has several etiologic factors that cause a similar physiologic dysfunction and risk. Aortic valve replacement leads to improved survival and quality of life. The primary mitral valve disease targeted is regurgitation, which occurs as a primary valve defect and as a secondary consequence of ventricular dysfunction. Primary mitral regurgitation is treated by valve repair with excellent long-term outcomes. Secondary regurgitation has poor long-term outcomes with current commonly used repair techniques and limited data exists showing that correction of the regurgitation improves survival. Adoption of TMVR will require overcoming the anatomic challenges as well as generating data that supports improved survival and/or quality of life.