Percutaneous valve replacement: Fact or fiction?

Percutaneous catheter-based interventions are an emerging area in the treatment of valvular heart disease. Despite many limitations related to device technology, valve durability and stability, and anatomical obstacles, the early results of percutaneous catheter-based valve repair and replacement are promising. The procedures are currently aimed at high-risk patients who cannot undergo conventional surgical management. The first percutaneous heart valve replacement occurred in 2002 in the pulmonary position. Subsequently, the early experience in the literature has reported over 50 human cases. The anatomical complexities of the aortic root have made success more elusive for percutaneous aortic valve replacement. Only a few cases have been reported, with variable success described. Percutaneous mitral valve replacement has not been reported to date; however, clinical trials are underway evaluating catheter-based techniques of mitral valve repair. Present enthusiasm should be tempered because scarcely more than 100 patients worldwide have undergone percutaneous valve interventions. Nonetheless, it is inevitable that as technology develops to overcome the present limitations and develop safe and effective techniques, percutaneous heart valve repair and replacement will undoubtedly increase in frequency. Scrupulously designed clinical trials must be performed to definitively determine the short- and long-term results of these procedures as compared with the gold standard of open surgical repair, as well as to define the appropriate patient population that will benefit the most.