Percutaneous valve replacement: a paradigm shift

PURPOSE OF REVIEW: Valvular heart disease is often associated with significant morbidity and mortality. Surgical treatment of stenotic or regurgitant valvular lesions can alter the natural history of the disease process, yielding excellent short and long-term results, meaning that this has been accepted as the gold standard for therapy of valvular disease. Surgical procedures can be associated with a significant rate of perioperative complications, however. These procedures are particularly associated with unacceptably high short and long-term morbidity and mortality in the elderly - a population group that has grown steadily over the years. Elderly patients often have significant comorbidities that preclude a safe and durable surgical correction of the valvular lesions in up to 31% of these high-risk cases. This review provides an overview of recent developments in percutaneous valve therapeutics. RECENT FINDINGS: Over the last decade, numerous technical developments in valvular interventions have focused on percutaneous valve replacement. There are percutaneous valve replacements on the horizon that promise to offer a novel approach to correct valvular lesions, especially in this high-risk surgical population. SUMMARY: Several devices are presently being evaluated in feasibility trials, and many new ones are being developed. Results with semilunar valves have generally been better than the atrioventricular valves. Long-term results of these treatment modalities are still unknown.