Valvular Interventions

By Ted E. Feldman, MD, FESC, FACC, FSCAI

Transcatheter valve therapies are rapidly developing, and in this issue, we update you on this dynamic field.

Konstantinos Spargias, MD, and Danny Dvir, MD, begin this issue with a look at minimally invasive treatment for failed bioprosthetic valves using the valve-in-valve technique in an often high-surgical-risk subset of patients. Pulmonary valve replacement is also becoming an area of heightened interest, and Damien Kenny, MB, MD; Qi-Ling Cao, MD; and Ziyad M. Hijazi, MD, MPH, FSCAI, discuss the current status of this technique and where we stand in terms of forthcoming technology.

As TAVR continues to be a topic of intense debate and research, Paul J. Pearson, MD, PhD, reflects on the question, “Who should undergo TAVR?”—an answer that will become quite pressing as the baby boomer generation begins to seek these interventions.

Moving to the mitral anatomy, Ralph Stephan von Bardeleben, MD, and Wolfgang Schillinger, MD, share their perspectives on the latest European registry findings of using the MitraClip device (Abbott Vascular, Santa Clara, CA) in patients with mitral regurgitation. Mike Saji, MD, and D. Scott Lim, MD, have also studied this technology and touch on these data from abroad, as well as the US COAPT trial. As you can see, this is a worldwide effort to improve the lives of our patients.

In the area of structural innovation, Arun Kanmanthareddy, MD; Yeruva Madhu Reddy, MD; Jayasree Pillarisetti, MD; Vijay Swarup, MD; and Dhanunjaya Lakkireddy, MD, describe use of the Watchman device (Boston Scientific Corporation, Natick, MA) for left atrial appendage exclusion and provide a review of the data collected to date. Steven J. Yakubov, MD, FACC, FSCAI, and Connor B. Yakubov then describe the percutaneous suture ligation technique for left atrial appendage closure using the Lariat device (SentreHeart, Inc., Redwood City, CA) to treat patients with atrial fibrillation.

In a roundtable interview, we probe the minds of John Spertus, MD, MPH, FACC, FAHA; William Fearon, MD; and Ralph G. Brindis, MD, MPH, MACC, FSCAI, regarding a recent analysis of the COURAGE trial that focuses on patients who crossed over from optimal medical therapy to revascularization and the results that inform practice protocols.

Next, we also speak with Barry T. Katzen, MD, FACC, FACR, FSIR, and Theodore L. Schreiber, MD, to get their thoughts on the use of robotic-assisted intervention and how it may be best utilized in today’s practice.

Finally, Tullio Palmerini, MD, discusses his recent investigations comparing drug-eluting stents and bare-metal stents, scores for predicting patient outcomes, and revascularization strategies in difficult disease presentations.

As always, we hope our reviews capture the essentials of the ever-expanding interventional cardiology literature. Let us know if there are topics you’d like to read about in future issues.

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