13.1 Key Points Transcatheter valve implantation is feasible in failing surgical aortic, mitral, pulmonic and tricuspid bioprostheses. Access may be transarterial (femoral, subclavian, axillary), transvenous (femoral, subclavian, jugular), transapical, transatrial, or direct transaortic. Paravalvular regurgitation (PR) must be distinguished from…
Paravalvular leak (PVL) complicating mechanical or bioprosthetic surgical valve replacement is an uncommon but occasional occurrence. Various series have demonstrated an incidence of 2% to 12% after mitral valve replacement (MVR) and 1% to 5% after aortic valve replacement (AVR).…
11.1 Key Points Percutaneous transcatheter therapies for mitral regurgitation (MR) have found a role for patients at high operative risk with both degenerative and functional pathologies. The MitraClip (Abbott Vascular Structural Heart, Menlo Park, Calif.) therapy utilizes a catheter-based system…
Percutaneous treatment of mitral regurgitation (MR) remains one of the most important areas of innovation and unmet clinical need in the field of adult structural heart disease. It is also one of the most challenging areas for device development because…
Before 1982, cardiac surgery was the conventional form of treatment for symptomatic stenotic valvular heart disease lesions. Today, percutaneous balloon dilation of stenotic cardiac valves is being used in many centers for the treatment of patients with pulmonic, mitral, aortic,…
As the twenty-first century progresses, a new chapter in cardiac therapeutics is being written with the development of transcatheter valve technologies. Percutaneous pulmonary valve implantation (PPVI) has the distinction of being the first percutaneous valve replacement in humans and has…
7.1 Key Points Transcatheter aortic valve replacement (TAVR) using the self-expanding Medtronic CoreValve Revalving System (Medtronic, Maple Grove, Minn.) transcatheter heart valve (THV) provides an alternative to surgical aortic valve replacement (SAVR) in patients who are poor candidates for surgery.…
Aortic stenosis (AS) remains the most common form of adult acquired valvular heart disease in developed countries, increasing in prevalence with age. As noted by Ross and Braunwald, the natural history of symptomatic AS carries a poor prognosis. Medically treated…
5.1 Balloon Aortic Valvuloplasty Balloon aortic valvuloplasty (BAV) for severe aortic stenosis (AS), a common disease of the elderly, was introduced by Dr. Cribier in 1986. Initial experience demonstrated the technical feasibility, acceptable safety, and fairly modest improvement in valve…
4.1 Importance of Transseptal Puncture The transseptal puncture has been in use since its description in 1959 by Drs. Ross, Braunwald and Morrow. Until recently, transseptal puncture has been used relatively rarely, primarily for diagnostic purposes and percutaneous balloon mitral…