Structural heart disease encompasses abnormalities in heart valves, septal defects, ventricular function and other anatomical issues. Interventional cardiologists are at the forefront of innovating minimally invasive transcatheter techniques to treat structural heart conditions. As these novel procedures rapidly evolve, keeping up with the latest advances can be challenging. This blog provides a comprehensive overview of revolutionary developments in structural heart interventions cardiologists should know.
Transcatheter Aortic Valve Replacement
Transcatheter aortic valve replacement (TAVR) has transformed the treatment of severe aortic stenosis over the past decade. While surgical aortic valve replacement (SAVR) remains the gold standard treatment for low to intermediate surgical risk patients, TAVR provides similar outcomes with a less invasive approach. The indications for TAVR continue to expand to lower risk demographics with excellent long-term durability now demonstrated out to 5 years. New iterations of transcatheter heart valves offer incremental benefits like improved sealing and positioning. Cerebral protection devices help minimize stroke risk. While challenges like paravalvular leak, valve thrombosis and pacemaker implantation remain, ongoing innovation aims to address these issues.
Mitral and Tricuspid Valve Repair
Transcatheter mitral valve repair with the MitraClip system provides a minimally invasive option for patients with severe mitral regurgitation who are not candidates for surgery. Clinical data supports improved survival, quality of life, and heart failure symptoms compared to medical therapy alone. New generation MitraClip devices are in development to improve ease of implantation. Functional tricuspid regurgitation can also be treated percutaneously with devices like the PASCAL clip which reinforce the valve annulus. While clinical experience is more limited for tricuspid intervention, early feasibility studies show promise in reducing regurgitation and improving functional capacity.
Left Atrial Appendage Closure
In atrial fibrillation patients with contraindications to oral anticoagulants, left atrial appendage closure is superior to no anticoagulation for preventing thromboembolic events. Devices like the Watchman FLX are implanted percutaneously, occluding the appendage to prevent clot formation. With high procedural success and safety, left atrial appendage closure is becoming widely adopted to reduce stroke risk. Long-term follow-up data out to 7 years confirms sustained benefits.
Structural heart interventions allow interventional cardiologists to reshape cardiac anatomy and physiology in revolutionary ways. As technologies continue to rapidly progress, keeping abreast of the latest developments through comprehensive reviews and trainings a key to providing optimal patient care. Advances like bioprosthetic valve frames, transcatheter mitral and tricuspid valve replacements, and remote implant monitoring will catalyze the next phase of innovation in the exciting field of structural heart disease.
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