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Surgery Insight: current advances in percutaneous heart valve replacement and repair

Nature Clinical Practice Cardiovascular Medicine volume 3, pages 256–264 (2006)Cite this article

Abstract

Several advances have been made in interventional cardiology, particularly in the field of valvular heart disease. Among the procedures for which technologies are available, percutaneous replacement of the pulmonary and aortic valves, and percutaneous repair of the mitral valve, via annuloplasty or the Alfieri method, are the best known. Along with the excitement generated by these new subspecialties, however, there has also been skepticism. In this article we focus on the current innovations that have been applied to the procedures in humans, and discuss the advantages and disadvantages of the different strategies.

Key Points

  • Percutaneous pulmonary valve replacement is feasible and has positive effects on right ventricular function

  • The mortality associated with percutaneous pulmonary valve replacement is zero, although limitations still exist in a notable number of patients who have large right ventricular outflow tracts

  • Percutaneous aortic valve replacement is feasible with bioprosthetic valves mounted on balloon-expandable and self-expandable stents

  • Although initial results of percutaneous aortic valve replacement are encouraging, delivery system size (currently 18–24 F) will have to be addressed for wider application of this procedure

  • Percutaneous mitral valve repair in humans includes techniques to perform edge-to-edge repair and annuloplasty via the coronary sinus

  • Limitations in percutaneous mitral valve repair will be seen mainly in patients with ischemic mitral regurgitation, in whom surgical repairs have historically not been as successful

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Figure 1: The current percutaneous stent valve used for treatment of pulmonary stenosis and regurgitation in patients with previous congenital heart repair.
Figure 2: The balloon-expandable, percutaneous heart valve used for treatment of aortic stenosis.
Figure 3: A bioprosthetic valve within the self-expanding stent frame used to treat aortic stenosis and regurgitation.
Figure 4: Two devices that reproduce the Alfieri edge-to-edge mitral valve repair method.

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Authors and Affiliations

  1. Interventional Cardiologists in the Department of Cardiology, Charles Nicolle Hospital, Rouen, France

    Vasilis Babaliaros, Alain Cribier & Carla Agatiello

Authors
  1. Vasilis Babaliaros
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  2. Alain Cribier
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  3. Carla Agatiello
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Corresponding author

Correspondence to Alain Cribier.

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Competing interests

Alain Cribier is a consultant for Edwards Lifesciences.

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Babaliaros, V., Cribier, A. & Agatiello, C. Surgery Insight: current advances in percutaneous heart valve replacement and repair. Nat Rev Cardiol 3, 256–264 (2006). https://doi.org/10.1038/ncpcardio0534

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