It is an exciting time for physicians involved in valve disease treatment. New solutions based on transcatheter technologies are becoming available to treat the most challenging patients. The session of today was well attended. Speakers engaged in a lively debate with the audience and the different opinions on these new techniques opened a number of controversies. It is recognized that new transcatheter procedures stem from long lasting surgical experience. This was delivered to the audience by relevant surgeons, who focused on the challenges and opportunities of these new therapeutic options.
Tomas Walter, from Leipzig, spoke first. He is the most experienced cardiac surgeon in the field of transapical aortic valve implantation. He emphasised in his presentation the value of close collaboration between surgeons and cardiologists. This is fundamental to bring the best from the two worlds to the patients: and to pursue safety and efficacy.
Ottavio Alfieri, the father of the Edge-to-edge mitral repair technique, clarified the indications and the surgical rules to get the best results with his technique “which is the only surgical technique suitable for leaflet repair today”. Although Alfieri sees a future for this technique in the cath lab, most of the attendees felt that many years are needed to see the widespread use of percutaneous mitral repair in their practice.
Emmanuel Lansac, from Bichat Hospital in Paris, is an expert in valve anatomy, function and physiology. He gave an outstanding lecture on the complex mitral annular anatomy and function. He also showed the limitations of coronary sinus annuloplasty, therefore opening the door for alternative options. But it was when Eberhard Grube went to the podium that the heat was on… He started his lecture stating that although all interventional techniques are derived from the surgical ones, “surgeons cannot teach anything to the interventionalists”… This position was strong enough to wake up the audience. Most of the attendees could feel the atmosphere of competition between professionals. Then he smoothed his position by stating that “surgical AVR is the golden treatment for aortic stenosis”. However, he expects a large proportion (>30%) of current surgical candidates will be submitted to percutaneous procedures five years from now….. To support this statement he reported the early promising results of endovascular AVR. He also sees an opening of indications to younger patients, once safety and efficacy become available. The discussion afterwards was lively. Mohr, above all, stated that indications should not be too liberal since complications happen after implantation of transcatheter valves, and current results of aortic surgery in younger candidates are excellent. He also reinforced the concept that close collaboration is the only way to overcome the limitations of the new technologies and to fix the eventual complications.
I left the room with only one thought. There is a solid future for the transcatheter valve procedures. They will impact our practice and will change the way we are treating our patients today. Physicians who will be involved will face several challenges, first of all, a new field of competition. But competition, usually, is the road to excellence.
Percutaneous valve therapy: is there anything the interventional cardiologist can learn from the surgeon? Symposium
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