Percutaneous transcatheter valve therapy

Aortic stenosis (AS) and mitral regurgitation (MR) are currently the commonest valvular pathologies in developed society. The current standard of treatment of severe AS and severe MR has been surgical aortic valve replacement (AVR) and mitral valve (MV) surgery. In 2002, the first humanpercutaneous AVR (PAVR) was performed and in 2005, results of percutaneous MV repair were also reported. The field of percutaneoustranscatheter valve therapy is evolving very rapidly. There are 2 aortic percutaneous heart valves in clinical trials and several others with first-in-man data or in pre-clinical testing. Results seem promising and it appears that PAVR will most likely be a viable option for selected patients in a relatively short time. The future of AS treatment will evolve with the advent of devices which will be repositionable and retrievable, as well as integrating other materials engineered by nanotechnology and tissue engineering. There are several technologies being investigated in the field of MV repair, each attempting to mimic surgical technique. Compared with PAVR, percutaneous MV repair is a more complex process as many different pathological processes can result in MR. The current technologies will be suitable only for carefully selected patients with a specific etiology of MR. Most likely a combination of these technologies will be required for satisfactory MV repair although MV replacement may be what many of those patients require, and therefore percutaneous MV replacement will be an exciting alternative in the near future.