Changing demographics of valvular heart disease and impact on surgical and transcatheter valve therapies.

Valvular heart disease remains frequent in industrialised countries since the decrease in frequency of rheumatic heart diseases has been accompanied by an increase in degenerative valve diseases. The prevalence of valvular disease increases sharply with age, as a consequence of the predominance of degenerative valvular diseases. Aortic stenosis and mitral regurgitation are the two most frequent diseases among patients referred because of valvular disease in Europe. The burden of heart valve disease in the elderly has an important impact on patient management, given the frequency of comorbidity and the increase in the risk of interventions. The changes in demographics explain why new procedures, such as transcatheter aortic valve implantation and percutaneous mitral valve repair, are potentially attractive in patients with high risk or even contraindications for surgery.