Percutaneous treatment of valvular heart disease: catheter-based aortic valve replacement and mitral valve repair therapies.

Until recently, percutaneous catheter therapy for valvular heart disease was limited to catheter balloon valvuloplasty for aortic, mitral, or pulmonic stenosis. A number of new approaches to percutaneous valve therapy are now developing rapidly, including methods for catheter-based valve replacement and repair. Stent-mounted valve prostheses have been successfully implanted in the pulmonic and aortic positions. These devices have been constructed using pericardial valve leaflets mounted inside balloon-expandable or self-expanding stents and have been used in patients who are high risk for valve replacement surgery. Percutaneous valve repair is also being developed for mitral regurgitation. Direct leaflet repair and percutaneous annuloplasty are being employed in clinical trials. All the percutaneous approaches are based on existing surgical techniques and offer less invasive alternatives. The era of percutaneous valve therapy has clearly arrived, and ongoing trials will define the clinical role for these new therapies.