The Year in Cardiology 2013: valvular heart disease (focus on catheter-based interventions)

Area of Science:

• Cardiology
• Interventional Cardiology
• Cardiac Surgery

Background:

• The multidisciplinary heart team approach is now standard for valvular heart disease (VHD) management, influenced by 2012 European guidelines.
• Transcatheter heart valve interventions gained prominence in 2013.
• Managing VHD in elderly patients presents complexity due to high rates of co-morbidity and frailty.

Purpose of the Study:

• To discuss the complex decision-making process for valvular heart disease (VHD) patients.
• To highlight the challenges in expanding transcatheter interventions to intermediate-risk populations.
• To emphasize the need for evidence from randomized clinical trials.

Main Methods:

• Review of current guidelines and clinical practice in VHD management.
• Analysis of patient selection criteria for surgical versus transcatheter interventions.
• Discussion of the role of the heart team in complex VHD cases.

Main Results:

• Decision-making for VHD patients who are poor surgical candidates but not yet suitable for catheter intervention is challenging.
• The prevalence of co-morbidity and frailty in older VHD patients complicates treatment choices.
• Current evidence primarily supports transcatheter interventions in high-risk surgical patients.

Conclusions:

• Transcatheter aortic valve implantation (TAVI) and similar interventions require further randomized trial data before wider adoption in intermediate-risk VHD patients.
• The heart team approach is crucial for optimizing VHD patient care.
• Future research should focus on generating robust evidence for less invasive VHD treatments.