Valvular heart diseases (VHD), like mitral or aortic valve disease, affect more than 40 million people across the world. Every year in the US alone, over 180,000 cardiac valve replacement surgeries are performed. Mitral regurgitation, Tricuspid regurgitation and Aortic stenosis are some of the common VHD. An important therapeutic option for such conditions is Transcatheter Valve repair.
Observations: A multidisciplinary team consisting of echocardiographers, nurses, radiologists, cardiothoracic surgeons and cardiologists is involved in all transcatheter valve therapies. This team is called the Heart team. This team determines the most suitable approach for the treatment of each patient. Patients with severe, symptomatic aortic stenosis can currently undergo an aortic valve replacement procedure called Transcatheter aortic valve implantation (TAVI). A self-expandable or balloon-expandable valve can be used to perform the TAVI procedure.
In a low-risk cohort of patients, about 8.5% of the patients receiving TAVI died due to stroke, rehospitalization or any other cause. For patients undergoing surgical aortic valve replacement, the death rate was about 15.1%. Anatomical factors such as annular size, number of leaflets and peripheral arterial anatomy, along with comorbidities like aortopathies and concomitant coronary artery disease, govern the choice of therapy for each individual. The US FDA has approved the use of mitral transcatheter edge-to-edge repair devices for high-risk patients in which it has excellent safety and efficacy.
The COAPT (Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients with Functional Mitral Regurgitation) trial noted that, for patients who underwent transcatheter edge-to-edge repair, the annualized rate of all hospitalizations for heart failure was low at 35.8% as compared to 67.9% among patients who did not undergo repair. As the trials are ongoing and show a favourable result, patients with tricuspid regurgitation have now the option of transcatheter tricuspid valve repair and replacement.
Conclusion: About 10,000 transcatheter mitral valve repairs and 78,000 TAVI procedures occur every year in the US. These procedures provide an efficacious and feasible treatment option to patients with mitral regurgitation and severe symptomatic aortic stenosis.