Progress in Transcatheter Approach to Valvular Heart Diseases

Aortic stenosis (AS) keeps being increased in our country in association with social aging, and the number of aortic valve replacement for elder patients has also grown. However, there were an innegligible number of inoperable patients with AS because of comorbidity and/or high frailty. For these patients, transcatheter aortic valve replacement (TAVR) has been recently available in Japan and is conducted in the authorized institutes. The PARTNER trial showed that TAVR was superior to standard medical therapy in patients who were not suitable candidates for surgery. Several studies have shown that TAVR is non-inferior to surgical AVR in patients with high operative risks, and TAVR is recommended as a therapeutic strategy for such high-risk patients in the guidelines of western countries.
For mitral regurgitation with high operative risks, in particular with severe ventricular dysfunction, the therapeutic strategy has not been established. In Europe and USA, MitraClip® has been approved as a noninvasive procedure for patients with severe mitral regurgitation and high operative risks, and a sponsor initiated clinical trial will be initiated soon in Japan. However, as EVEREST II trial showed, its clinical usefulness has not been established.
In this session, we would like to discuss the efficiency and safety of less invasive approach to valvular heart diseases in comparison with standard surgical approach, leading to the establishment of therapeutic strategy of valvular heart diseases in near future.