[Grey zones on valvular heart disease: interventional cardiology versus cardiac surgery. Expert opinion]

Area of Science:

• Cardiology
• Interventional Cardiology
• Clinical Guidelines

Background:

• Clinical guidelines offer therapeutic direction but contain evidence gaps ('grey zones').
• A 2018 Bergamo conference convened experts to address these grey zones in cardiology.

Purpose of the Study:

• To identify and discuss controversies in the percutaneous treatment of valvulopathies.
• To provide expert consensus on managing evidence gaps in clinical practice.

Main Methods:

• Expert symposium and comparative analysis of percutaneous interventional versus surgical approaches.
• Review of durability of aortic bioprostheses.
• Evaluation of transcatheter aortic valve replacement (TAVR) for low-risk patients.
• Assessment of percutaneous mitral valve repair using the MitraClip system.

Main Results:

• Discussion on the comparative durability of aortic bioprostheses (percutaneous vs. surgical).
• Consideration of extending TAVR to low-risk patient populations.
• Analysis of evidence for percutaneous treatment of functional mitral regurgitation with MitraClip.

Conclusions:

• The manuscript presents expert statements on key controversies in percutaneous valvulopathy treatment.
• Evidence from recent randomized trials published after the conference is integrated.
• The aim is to illuminate clinical practice by addressing current evidence limitations.