Abstract
The surgical treatment for valvular heart disease is well established with excellent long-term outcomes in appropriately selected patients. For patients at elevated risk for surgical intervention, options have traditionally been limited to medical therapy with disappointing results. The advent of transcatheter techniques of valvular repair or replacement has revolutionized treatment options for these patients at significantly elevated risk for surgery. In both the aortic and mitral realms, landmark clinical trials and real-world registries have begun to define the roles of these therapies, and the development of multidisciplinary heart teams have helped optimize patient treatment pathways and outcomes. Transcatheter treatment of aortic stenosis and mitral regurgitation has emerged as an approved option for properly selected patients, and guidelines have evolved to include these therapies. Further procedural refinement, device development, and clinical trials will continue to evolve this field.
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References
Souttar, H. S. (1925). The surgical treatment of mitral stenosis. Br Med J, 2(3379), 603–606.
Bailey, C. P. (1949). The surgical treatment of mitral stenosis (mitral commissurotomy). Dis Chest, 15(4), 377–397.
Campbell, J. M. (1950). An artificial aortic valve; preliminary report. J Thorac Surg, 19(2), 312–318.
Hufnagel, C. A., Harvey, W. P., Rabil, P. J., & McDermott, T. F. (1954). Surgical correction of aortic insufficiency. Surgery, 35(5), 673–683.
Otto, C. M., Pearlman, A. S., & Gardner, C. L. (1989). Hemodynamic progression of aortic stenosis in adults assessed by Doppler echocardiography. J Am Coll Cardiol, 13(3), 545–550.
Rosenhek, R., Binder, T., Porenta, G., et al. (2000). Predictors of outcome in severe, asymptomatic aortic stenosis. N Engl J Med, 343(9), 611–617.
Ross, J., Jr., & Braunwald, E. (1968). Aortic stenosis. Circulation, 38(1 Suppl), 61–67.
Bonow, R. O., Carabello, B. A., Chatterjee, K., et al. (2008). Focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to revise the 1998 guidelines for the management of patients with valvular heart disease). Endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J Am Coll Cardiol, 52(13), e1–142.
Vahanian, A., Baumgartner, H., Bax, J., et al. (2007). Guidelines on the management of valvular heart disease: the Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology. Eur Heart J, 28(2), 230–268.
Finks, J. F., Osborne, N. H., & Birkmeyer, J. D. (2011). Trends in hospital volume and operative mortality for high-risk surgery. N Engl J Med, 364(22), 2128–2137.
Svensson, L. G., Adams, D. H., Bonow, R. O., et al. (2013). Aortic valve and ascending aorta guidelines for management and quality measures: executive summary. Ann Thorac Surg, 95(4), 1491–1505.
Shahian, D. M., He, X., Jacobs, J. P., et al. (2012). The Society of Thoracic Surgeons Isolated Aortic Valve Replacement (AVR) Composite Score: a report of the STS Quality Measurement Task Force. Ann Thorac Surg, 94(6), 2166–2171.
Thourani, V. H., Ailawadi, G., Szeto, W. Y., et al. (2011). Outcomes of surgical aortic valve replacement in high-risk patients: a multiinstitutional study. Ann Thorac Surg, 91(1), 49–55. discussion 55–46.
Iturra, S. A., Suri, R. M., Greason, K. L., et al. (2014). Outcomes of surgical aortic valve replacement in moderate risk patients: implications for determination of equipoise in the transcatheter era. J Thorac Cardiovasc Surg, 147(1), 127–132.
Iung, B., Baron, G., Butchart, E. G., et al. (2003). A prospective survey of patients with valvular heart disease in Europe: The Euro Heart Survey on Valvular Heart Disease. Eur Heart J, 24(13), 1231–1243.
Cribier, A., Savin, T., Saoudi, N., Rocha, P., Berland, J., & Letac, B. (1986). Percutaneous transluminal valvuloplasty of acquired aortic stenosis in elderly patients: an alternative to valve replacement? Lancet, 1(8472), 63–67.
Percutaneous balloon aortic valvuloplasty. Acute and 30-day follow-up results in 674 patients from the NHLBI Balloon Valvuloplasty Registry. Circulation. Dec 1991;84(6):2383–2397.
McKay, R. G. (1991). The Mansfield scientific aortic valvuloplasty registry: overview of acute hemodynamic results and procedural complications. J Am Coll Cardiol, 17(2), 485–491.
Letac, B., Gerber, L. I., & Koning, R. (1988). Insights on the mechanism of balloon valvuloplasty in aortic stenosis. Am J Cardiol, 62(17), 1241–1247.
Letac, B., Cribier, A., Eltchaninoff, H., Koning, R., & Derumeaux, G. (1991). Evaluation of restenosis after balloon dilatation in adult aortic stenosis by repeat catheterization. Am Heart J, 122(1 Pt 1), 55–60.
Ben-Dor, I., Pichard, A. D., Satler, L. F., et al. (2010). Complications and outcome of balloon aortic valvuloplasty in high-risk or inoperable patients. J Am Coll Cardiol Intv, 3(11), 1150–1156.
O’Keefe, J. H., Jr., Vlietstra, R. E., Bailey, K. R., & Holmes, D. R., Jr. (1987). Natural history of candidates for balloon aortic valvuloplasty. Mayo Clin Proc. Mayo Clin, 62(11), 986–991.
Otto, C. M., Mickel, M. C., Kennedy, J. W., et al. (1994). Three-year outcome after balloon aortic valvuloplasty. Insights into prognosis of valvular aortic stenosis. Circulation, 89(2), 642–650.
Cribier, A., Eltchaninoff, H., Bash, A., et al. (2002). Percutaneous transcatheter implantation of an aortic valve prosthesis for calcific aortic stenosis: first human case description. Circulation, 106(24), 3006–3008.
Leon, M. B., Smith, C. R., Mack, M., et al. (2010). Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery. N Engl J Med, 363(17), 1597–1607.
Smith, C. R., Leon, M. B., Mack, M. J., et al. (2011). Transcatheter versus surgical aortic-valve replacement in high-risk patients. N Engl J Med, 364(23), 2187–2198.
Popma, J. (2013). CoreValve US pivotal trial extreme risk iliofemoral study results. San Francisco, CA: Paper presented at: TCT 20132013.
(2014). CMS NCD. Available at: http://www.cms.gov/medicare-coverage-database/details/nca-decision-memo.aspx?NCAId=257&ver=4&NcaName=TranscatheterAorticValveReplacement(TAVR)&bc=ACAAAAAAIAAA&. Accessed 1/20/2014.
Tommaso, C. L., Bolman, R. M., 3rd, Feldman, T., et al. (2012). Multisociety (AATS, ACCF, SCAI, and STS) expert consensus statement: operator and institutional requirements for transcatheter valve repair and replacement, part 1: transcatheter aortic valve replacement. J Am Coll Cardiol, 59(22), 2028–2042.
Mack, M. J., Brennan, J. M., Brindis, R., et al. (2013). Outcomes following transcatheter aortic valve replacement in the United States. JAMA, 310(19), 2069–2077.
Holmes, D. R., Jr., Rich, J. B., Zoghbi, W. A., & Mack, M. J. (2013). The heart team of cardiovascular care. J Am Coll Cardiol, 61(9), 903–907.
Holmes, D. R., Jr., Mack, M. J., Kaul, S., et al. (2012). ACCF/AATS/SCAI/STS expert consensus document on transcatheter aortic valve replacement. J Am Coll Cardiol, 59(13), 1200–1254.
Dubois, C., Coosemans, M., Rega, F., et al. (2013). Prospective evaluation of clinical outcomes in all-comer high-risk patients with aortic valve stenosis undergoing medical treatment, transcatheter or surgical aortic valve implantation following heart team assessment. Interact Cardiovasc Thorac Surg, 17(3), 492–500.
Omer, S., Kar, B., Cornwell, L. D., et al. (2013). Early experience of a transcatheter aortic valve program at a Veterans Affairs facility. JAMA Surg, 148(12), 1087–1093.
Makkar, R. R., Jilaihawi, H., Mack, M., et al. (2013). Stratification of outcomes after transcatheter aortic valve replacement according to surgical inoperability for technical versus clinical reasons. Journnal of the American College of Cardiology Oct 12.
Dvir, D., Waksman, R., Barbash, I. M, et al. (2013). Outcomes of patients with chronic lung disease and severe aortic stenosis treated with transcatheter versus surgical aortic valve replacement or standard therapy: insights from the PARTNER trial. Journal of the American College of Cardiology. Oct 1 2013.
Le Ven, F., Freeman, M., Webb, J., et al. (2013). Impact of low flow on the outcome of high-risk patients undergoing transcatheter aortic valve replacement. J Am Coll Cardiol, 62(9), 782–788.
Herrmann, H. C., Pibarot, P., Hueter, I., et al. (2013). Predictors of mortality and outcomes of therapy in low-flow severe aortic stenosis: a placement of aortic transcatheter valves (PARTNER) trial analysis. Circulation, 127(23), 2316–2326.
Leon, M. B., Piazza, N., Nikolsky, E., et al. (2011). Standardized endpoint definitions for transcatheter aortic valve implantation clinical trials: a consensus report from the valve academic research consortium. J Am Coll Cardiol, 57(3), 253–269.
Genereux, P., Head, S. J., Van Mieghem, N. M., et al. (2012). Clinical outcomes after transcatheter aortic valve replacement using valve academic research consortium definitions: a weighted meta-analysis of 3,519 patients from 16 studies. J Am Coll Cardiol, 59(25), 2317–2326.
Genereux, P., Webb, J. G., Svensson, L. G., et al. (2012). Vascular complications after transcatheter aortic valve replacement: insights from the PARTNER (Placement of AoRTic TraNscathetER Valve) trial. J Am Coll Cardiol, 60(12), 1043–1052.
Miller, D. C., Blackstone, E. H., Mack, M. J., et al. (2012). Transcatheter (TAVR) versus surgical (AVR) aortic valve replacement: occurrence, hazard, risk factors, and consequences of neurologic events in the PARTNER trial. J Thorac Cardiovasc Surg, 143(4), 832–843. e813.
Schewel, D., Frerker, C., Schewel, J., et al. (2013). Clinical impact of paravalvular leaks on biomarkers and survival after transcatheter aortic valve implantation. Catheterization and Cardiovascular Interventions. Nov 21 2013.
Kodali, S. K., Williams, M. R., Smith, C. R., et al. (2012). Two-year outcomes after transcatheter or surgical aortic-valve replacement. N Engl J Med, 366(18), 1686–1695.
Genereux, P., Head, S. J., Hahn, R., et al. (2013). Paravalvular leak after transcatheter aortic valve replacement: the new Achilles’ heel? A comprehensive review of the literature. J Am Coll Cardiol, 61(11), 1125–1136.
Gurvitch, R., Webb, J. G., Yuan, R., et al. (2011). Aortic annulus diameter determination by multidetector computed tomography: reproducibility, applicability, and implications for transcatheter aortic valve implantation. J Am Coll Cardiol Intv, 4(11), 1235–1245.
Binder, R. K., Webb, J. G., Willson, A. B., et al. (2013). The impact of integration of a multidetector computed tomography annulus area sizing algorithm on outcomes of transcatheter aortic valve replacement: a prospective, multicenter, controlled trial. J Am Coll Cardiol, 62(5), 431–438.
Altiok, E., Koos, R., Schroder, J., et al. (2011). Comparison of two-dimensional and three-dimensional imaging techniques for measurement of aortic annulus diameters before transcatheter aortic valve implantation. Heart, 97(19), 1578–1584.
Jilaihawi, H., Doctor, N., Kashif, M., et al. (2013). Aortic annular sizing for transcatheter aortic valve replacement using cross-sectional 3-dimensional transesophageal echocardiography. J Am Coll Cardiol, 61(9), 908–916.
Meredith, Am IT., Worthley, S. G, Whitbourn, R. J, et al. (2013). Transfemoral aortic valve replacement with the repositionable Lotus Valve System in high surgical risk patients: the REPRISE I study. EuroIntervention. Oct 31 2013.
Ward, C., & Hancock, B. W. (1975). Extreme pulmonary hypertension caused by mitral valve disease. Natural history and results of surgery. Br Heart J, 37(1), 74–78.
Selzer, A., & Cohn, K. E. (1972). Natural history of mitral stenosis: a review. Circulation, 45(4), 878–890.
Bonow, R. O., Carabello, B. A., Kanu, C., et al. (2006). ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to revise the 1998 guidelines for the management of patients with valvular heart disease): developed in collaboration with the Society of Cardiovascular Anesthesiologists: endorsed by the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic Surgeons. Circulation, 114(5), e84–231.
Ben Farhat, M., Ayari, M., Maatouk, F., et al. (1998). Percutaneous balloon versus surgical closed and open mitral commissurotomy: seven-year follow-up results of a randomized trial. Circulation, 97(3), 245–250.
Inoue, K., Owaki, T., Nakamura, T., Kitamura, F., & Miyamoto, N. (1984). Clinical application of transvenous mitral commissurotomy by a new balloon catheter. J Thorac Cardiovasc Surg, 87(3), 394–402.
Palacios, I. F., Sanchez, P. L., Harrell, L. C., Weyman, A. E., & Block, P. C. (2002). Which patients benefit from percutaneous mitral balloon valvuloplasty? Prevalvuloplasty and postvalvuloplasty variables that predict long-term outcome. Circulation, 105(12), 1465–1471.
Wilkins, G. T., Weyman, A. E., Abascal, V. M., Block, P. C., & Palacios, I. F. (1988). Percutaneous balloon dilatation of the mitral valve: an analysis of echocardiographic variables related to outcome and the mechanism of dilatation. Br Heart J, 60(4), 299–308.
Iung, B., Cormier, B., Ducimetiere, P., et al. (1996). Functional results 5 years after successful percutaneous mitral commissurotomy in a series of 528 patients and analysis of predictive factors. J Am Coll Cardiol, 27(2), 407–414.
Cannan, C. R., Nishimura, R. A., Reeder, G. S., et al. (1997). Echocardiographic assessment of commissural calcium: a simple predictor of outcome after percutaneous mitral balloon valvotomy. J Am Coll Cardiol, 29(1), 175–180.
Dean, L. S., Mickel, M., Bonan, R., et al. (1996). Four-year follow-up of patients undergoing percutaneous balloon mitral commissurotomy. A report from the National Heart, Lung, and Blood Institute Balloon Valvuloplasty Registry. J Am Coll Cardiol, 28(6), 1452–1457.
Enriquez-Sarano, M., Avierinos, J. F., Messika-Zeitoun, D., et al. (2005). Quantitative determinants of the outcome of asymptomatic mitral regurgitation. N Engl J Med, 352(9), 875–883.
David, T. E., Uden, D. E., & Strauss, H. D. (1983). The importance of the mitral apparatus in left ventricular function after correction of mitral regurgitation. Circulation, 68(3 Pt 2), II76–82.
Perier, P., Clausnizer, B., & Mistarz, K. (1994). Carpentier “sliding leaflet” technique for repair of the mitral valve: early results. Ann Thorac Surg, 57(2), 383–386.
Carpentier, A., Chauvaud, S., Fabiani, J. N., et al. (1980). Reconstructive surgery of mitral valve incompetence: ten-year appraisal. J Thorac Cardiovasc Surg, 79(3), 338–348.
Gillinov, A. M., Cosgrove, D. M., Blackstone, E. H., et al. (1998). Durability of mitral valve repair for degenerative disease. J Thorac Cardiovasc Surg, 116(5), 734–743.
Maisano, F., Caldarola, A., Blasio, A., De Bonis, M., La Canna, G., & Alfieri, O. (2003). Midterm results of edge-to-edge mitral valve repair without annuloplasty. J Thorac Cardiovasc Surg, 126(6), 1987–1997.
McGee, E. C., Gillinov, A. M., Blackstone, E. H., et al. (2004). Recurrent mitral regurgitation after annuloplasty for functional ischemic mitral regurgitation. J Thorac Cardiovasc Surg, 128(6), 916–924.
Acker, M. A., Parides, M. K., Perrault, L. P., et al. (2014). Mitral-valve repair versus replacement for severe ischemic mitral regurgitation. N Engl J Med, 370(1), 23–32.
Alfieri, O., Maisano, F., De Bonis, M., et al. (2001). The double-orifice technique in mitral valve repair: a simple solution for complex problems. J Thorac Cardiovasc Surg, 122(4), 674–681.
Feldman, T., Kar, S., Rinaldi, M., et al. (2009). Percutaneous mitral repair with the MitraClip system: safety and midterm durability in the initial EVEREST (Endovascular Valve Edge-to-Edge REpair Study) cohort. J Am Coll Cardiol, 54(8), 686–694.
Argenziano, M., Skipper, E., Heimansohn, D., et al. (2010). Surgical revision after percutaneous mitral repair with the MitraClip device. Ann Thorac Surg, 89(1), 72–80. discussion p 80.
Mauri, L., Foster, E., Glower, D. D., et al. (2013). 4-year results of a randomized controlled trial of percutaneous repair versus surgery for mitral regurgitation. J Am Coll Cardiol, 62(4), 317–328.
Feldman, T., Foster, E., Glower, D. D., et al. (2011). Percutaneous repair or surgery for mitral regurgitation. N Engl J Med, 364(15), 1395–1406.
Whitlow, P. L., Feldman, T., Pedersen, W. R., et al. (2012). Acute and 12-month results with catheter-based mitral valve leaflet repair: the EVEREST II (Endovascular Valve Edge-to-Edge Repair) High Risk Study. J Am Coll Cardiol, 59(2), 130–139.
Armstrong, E. J., Rogers, J. H., Swan, C. H., et al. (2013). Echocardiographic predictors of single versus dual MitraClip device implantation and long-term reduction of mitral regurgitation after percutaneous repair. Catheter Cardiovasc Interv, 82(4), 673–679.
Maisano, F., Franzen, O., Baldus, S., et al. (2013). Percutaneous mitral valve interventions in the real world: early and 1-year results from the ACCESS-EU, a prospective, multicenter, nonrandomized post-approval study of the MitraClip therapy in Europe. J Am Coll Cardiol, 62(12), 1052–1061.
Masson, J. B., & Webb, J. G. (2009). Percutaneous mitral annuloplasty. Coron Artery Dis, 20(3), 183–188.
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Steinberg, D.H., Castillo-Sang, M. & Powers, E.R. Advances in Transcatheter Valve Therapies. J. of Cardiovasc. Trans. Res. 7, 375–386 (2014). https://doi.org/10.1007/s12265-014-9561-9
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DOI: https://doi.org/10.1007/s12265-014-9561-9