Structural heart disease encompasses congenital and acquired noncoronary cardiac pathologies which can present throughout the lifespan. In adult patients, there has been a shift in management from predominantly surgical to a minimally invasive catheter-based approach. This has expanded the population of patients eligible for treatment by offering patients at high or prohibitive risk for surgery an option. In addition, many catheter-based interventions are supported by randomized and observational studies demonstrating the safety and efficacy of the devices and short patient recovery times. Today, many types of procedures are performed in the outpatient or observation setting. Transcatheter aortic valve replacement (TAVR) for severe aortic stenosis (AS) has supplanted surgical AVR in all but the lowest surgical risk patients including those indicated for a mechanical prosthesis, and those requiring additional valvular, aortic, or coronary procedures. TAVR can be appropriate in special populations such as patients with bicuspid aortic valves and is often chosen in patients with a failed bioprosthesis, termed a valve-on-valve procedure. While the femoral artery is the main access for TAVR, alternative access options have been developed for patients with severe peripheral vascular disease that have replaced the transapical approach, including trans-axillary, trans-cava, and trans-carotid. Whether TAVR can improve outcomes in symptomatic patients with moderate AS is under investigation. Paravalvular leaks (PVL), which complicate both catheter-based and surgical valves, can result in complications such as heart failure and hemolysis and often require treatment. Transcatheter PVL closure techniques and devices have improved and expanded over the past two decades and are the preferred method of closure in many centers. The regurgitant valvular disease has been more challenging to treat with a percutaneous approach. Transcatheter mitral valve repair (TMVR) with the MitraClip has a role in the management of certain populations with severe MR. Patient selection based on clinical and anatomic factors, and optimization of medical therapy are important considerations with this device. Several devices or under development for mitral and tricuspid regurgitation may expand minimally invasive options for patients. This issue of the journal provides focused reviews on the current and future state of adult percutaneous structural heart interventions.
Prof. Dr. Jinnette D. Abbott
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