Evolving paradigms in valvular heart disease: where should guidelines move?

Introduction

It has been a fascinating decade for transcatheter procedures targeting the aortic and mitral valve disease. Over last ten years we had the privilege to witness steady growth of evidence supporting the use of interventional structural heart disease, especially the transcatheter aortic valve implantation (TAVI).

The past

Looking back to the year 2010, two pivotal PARNTER trials paved the way by reporting staggering mortality benefit of TAVI in the inoperable group of aortic stenosis patients. This was also the time when the first TAVI procedures were performed in many pioneering centers across Europe. I recall that morning at our center, when excitement was mixed with hesitation whether this type of procedure will survive and be adopted as a standard of care for inoperable patients. Nothing was certain for us at that time. Interestingly, it was the cardiosurgeon who in the postprocedural wrap-up shared his frank and confident comment saying, “it is just a matter of time when TAVI will be offered to young patients with low surgical risks as a more acceptable option allowing for quick recovery and shorter rehabilitation”.

The present

Looking back to the year 2010, two pivotal PARNTER trials paved the way by reporting staggering mortality benefit of TAVI in the inoperable group of aortic stenosis patients. This was also the time when the first TAVI procedures were performed in many pioneering centers across Europe. I recall that morning at our center, when excitement was mixed with hesitation whether this type of procedure will survive and be adopted as a standard of care for inoperable patients. Nothing was certain for us at that time. Interestingly, it was the cardiosurgeon who in the postprocedural wrap-up shared his frank and confident comment saying, “it is just a matter of time when TAVI will be offered to young patients with low surgical risks as a more acceptable option allowing for quick recovery and shorter rehabilitation”.

The future

At present there is more than twenty new technologies in research and design pipelines targeting the mitral, tricuspid and pulmonary valve disfunctions. Taking into account all of the above, it maybe legitimate to cautiously speculate that transcatheter interventions are likely to strengthen their position in the upcoming 2021 ESC guidelines.