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Percutaneous valve replacement: a fad or an advance?

Nature Clinical Practice Cardiovascular Medicine volume 1, pages 62–63 (2004)Cite this article

In the field of medicine, and particularly in cardiology, a shift has been made possible from invasive treatment such as surgery, to less-invasive procedures such as interventional catheterization.1 This move has reduced morbidity, mortality, discomfort to patients and procedure cost. Examples are balloon valvuloplasty of obstructive lesions, closure of heart defects and stenting of vascular stenosis. Despite transcatheter treatment of valvular diseases being well established for obstructive lesions, cardiac valve replacement has remained entirely in the surgical field. The prospect of nonsurgical transcatheter replacement of cardiac valves, or percutaneous valve replacement (PVR), holds immense promise for the management of patients. PVR uses a biologic or synthetic valve mounted on a balloon-expandable stent, a self-expandable stent or both. Stent designs vary greatly because of the underlying morphologic differences between left-ventricular outflow tracts and right-ventricular outflow tracts (RVOT). Here we discuss PVR of pulmonary and aortic valves, giving the current status and the future prospect of these procedures.

Several congenital heart diseases involving the RVOT require surgical repair in early childhood, in which a prosthetic conduit is interposed between the right ventricle and the pulmonary artery. The life span of these conduits is limited, committing patients to multiple reoperations.2 Pulmonary insufficiency, created by the insertion of a stent or by transannular patching to repair tetralogy of Fallot, has been considered a benign lesion and, therefore, neglected for a long time. Long-term follow-up has, however, revealed the damaging effects of pulmonary insufficiency on the right ventricle,3 although restoration of valve competence does not always improve right-ventricular function.4 The negative effects of extracorporeal circulation on myocardial protection of the right ventricle are frequently blamed. A nonsurgical approach might, therefore, be valuable in patients with pulmonary insufficiency, obstruction or both.

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Authors and Affiliations

  1. the Department of Pediatric Cardiology, Necker Hospital, Paris, France

    Younes Boudjemline

  2. Professor of Cardiology at Great Ormond Street Hospital for Children NHS Trust, London, UK

    Philipp Bonhoeffer

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  1. Younes Boudjemline
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  2. Philipp Bonhoeffer
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Correspondence to Philipp Bonhoeffer.

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The authors declare no competing financial interests.

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Boudjemline, Y., Bonhoeffer, P. Percutaneous valve replacement: a fad or an advance?. Nat Rev Cardiol 1, 62–63 (2004). https://doi.org/10.1038/ncpcardio0043

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