Current status of valvular surgery

Surgical treatment of valvular heart disease is a field of constant clinical and experimental research. Recently, much attention has been devoted to the improvement of valve repair techniques. The physiopathology of the left ventricular outflow tract obstruction following mitral valve repair has become better understood. Surgical techniques to correct this infrequent complication have been developed. Conservative valvular surgery or homograft use are among the surgical treatments for infective endocarditis; innovative experimental and clinical studies on mitral and tricuspid homografts have provided interesting results. New biological valves have come into use; intraoperative creation of a cardiac bioprosthesis using glutaraldehyde-treated autologous pericardium is an attractive surgical innovation. Stentless bioprostheses are also under investigation, to evaluate their hemodynamic and clinical characteristics. The biology of bioprosthesis deterioration progresses at the cellular level, with the implication of phagocytosis as a contributing factor.