Valvular heart disease: improved procedural success and prediction of outcomes

For the podcast associated with this article, please visit https://academic.oup.com/eurheartj/pages/Podcasts. Aortic valve disease increases in prevalence and incidence with age, particularly after age 60. As the biology of this disease is still poorly understood,1 the only current treatment is valve replacement. Until recently, this was the field for surgeons; however, with the development of transarterial valve implantation or TAVI, interventional cardiologists expanded their therapeutic spectrum substantially, initially in high-risk2 and more recently even in low-risk patients.3 This Focus Issue on valvular heart disease starts with the ‘The year in cardiology: valvular heart disease’ by Bernard Prendergast from the John Radcliffe Hospital in Oxford, UK, and colleagues.4 They remind us that after decades as a Cinderella discipline, valvular heart disease now occupies the centre stage of cardiovascular medicine. Changing societal demographics and an ageing population (with increasing prevalence of degenerative disease), advances in imaging, and the explosion of interest in TAVI (supported by a series of landmark clinical trials) have attracted clinicians, researchers, engineers, device manufacturers, and investors, and transformed the landscape of clinical management. Indeed, a recent meta-analysis concluded that compared with surgical valve replacement, TAVI is associated with a reduction in all-cause mortality and stroke up to 2 years irrespective of baseline surgical risk and type of system used.5 However, the incidence of stroke and pacemaker implantation was lower in those undergoing TAVI with balloon-expandable compared with self-expandable valves. In contrast, patients treated with new-generation balloon-expandable valves more often suffered from major or life-threatening bleedings than those with new-generation self-expandable valves, while mortality at 30 days was not different. Thus, 2019 has been a ‘leap’ year for valvular heart disease, and TAVI procedures will further increase.6