Cardiac Valve Repair and Replacement: Are Transcatheter Options Here to Stay?

Valvular heart disease (VHD) affects millions worldwide and remains a major cause of morbidity and mortality, placing a substantial and growing burden on healthcare systems. Over the past two decades, transcatheter therapies have emerged to meet this challenge, transforming the management of aortic, mitral, and tricuspid valve disease. Initially developed for inoperable or high-risk surgical patients, procedures such as transcatheter aortic valve implantation (TAVI) and mitral transcatheter edge-to-edge repair (M-TEER) are now routinely offered across a broader risk spectrum. More recently, tricuspid therapies, including tricuspid transcatheter edge-to-edge repair (T-TEER) and transcatheter valve replacement (TTVR), have emerged to address a significant unmet clinical need. With transcatheter interventions becoming more widely available, clinicians across general and acute medical specialities are increasingly likely to encounter patients before and after these procedures. Familiarity with these therapies will support better decision-making and coordinated care. This review summarises the evolution of transcatheter valve therapy, its role alongside surgery, and the evidence supporting its use. Surgery remains the gold standard for younger or low-risk patients, particularly where long-term durability is essential. Transcatheter therapies now offer safe and effective treatment for older patients, including those with frailty or significant comorbidity, supported by landmark trials, which have demonstrated favourable clinical outcomes in carefully selected populations and underpinned guideline endorsement across risk categories. The importance of the multidisciplinary Heart Team is emphasised, ensuring treatment decisions reflect individual anatomy, comorbidity burden, life expectancy, and procedural risk. As device technology, imaging, and procedural expertise continue to advance, the integration of surgical and transcatheter approaches will support more individualised care and broaden access to definitive treatment for patients across the clinical spectrum.