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Emerging Transcatheter Therapies for Aortic and Mitral Disease
  1. Ryan D Christofferson
  1. Cleveland Clinic Foundation, United States
    1. Samir R Kapadia
    1. Cleveland Clinic Foundation, United States
      1. Vivek Rajagopal
      1. Cleveland Clinic Foundation, United States
        1. E Murat Tuzcu (tuzcue{at}ccf.org)
        1. Cleveland Clinic Foundation, United States

          Abstract

          Introduction Valvular heart disease is a common malady, affecting millions of people in the United States and worldwide.1 The incidence of degenerative and functional valvular disease is rising with the aging population and the increase in congestive heart failure patients.2 Established treatment methods require surgery, as medical therapy has not provided significant advantages for these patients. Although surgical valve repair or replacement has been well established as a safe and effective alternative,3 the procedure is invasive and still carries a significant morbidity and mortality risk, especially among patients with serious comorbidities or very elderly patients. The introduction of transcatheter valve therapies is intended to reduce the morbidity and mortality of mechanical valve intervention for higher-risk patients.<BR> The design and implementation of transcatheter valve therapies differ greatly based on the valve needing treatment and the approach utilized. The dominant design of valves developed for the aortic and pulmonic positions are stent-based bioprosthetic valves, advanced over a balloon and expanded within the original valve, a conduit, or deployed within a self-expanding stent device. Approaches to the mitral position are more varied in terms of device designs, including direct leaflet modification (clip or suture), indirect annuloplasty using the coronary sinus, direct annuloplasty and ventricular geometric modification.

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