[Evidence-based treatment of valvular heart disease]

Valvular heart disease is a major cause of cardiovascular morbidity and mortality worldwide. As the prevalence of most valvular heart diseases increases with age, population ageing has led to a substantial increase in disease burden. Due to advanced age or significant comorbidities, many patients are considered unsuitable for conventional surgery. Whereas medical therapy was therefore often the only treatment option in the past, the rapid evolution of transcatheter interventions has fundamentally transformed the management of valvular heart disease over the past two decades. Today, effective catheter-based treatment options are available for virtually all valvular pathologies. For patients with severe symptomatic aortic stenosis, the prognostic benefit of transcatheter aortic valve replacement is firmly established. Large randomized trials have demonstrated non-inferiority of transcatheter aortic valve replacement compared with surgical aortic valve replacement across most patient populations, leading to an expanding use of this approach in younger and lower-risk patients. Similarly, transcatheter edge-to-edge repair for mitral and tricuspid regurgitation has been shown to improve symptoms, quality of life, and heart failure-related hospitalizations. In carefully selected patients with secondary mitral regurgitation, this strategy also confers a survival benefit. In addition, dedicated transcatheter devices have recently emerged as promising treatment options for native aortic regurgitation. Given the rapid evolution of transcatheter therapies, current efforts are increasingly focused on selecting the optimal treatment strategy for the individual patient and determining the optimal timing of intervention.