Percutaneous approaches to valvular heart disease after previous cardiac surgery

While open surgical correction is the best treatment for most patients with valvular heart disease, there have been recent technical advances that permit percutaneous approaches to valve replacement and valve repair in selected circumstances. The most widely accepted catheter-based therapy for valvular heart disease is percutaneous balloon dilatation for rheumatic mitral valve stenosis, and this might be applicable to some patients who require relief of mitral valve stenosis after previous aortic or tricuspid valve surgery. As discussed earlier, degenerative mitral valve disease is the most common mitral valve etiology in Western populations, and considerable effort has been extended toward catheter-based methods for repair of mitral valve prolapse. Patients with aortic valve stenosis constitute the largest population of patients who might be considered for transcatheter therapy. Percutaneous and transapical insertion of collapsible bioprostheses has been used widely in elderly high-risk patients, and many of these patients have had previous cardiac surgery [1, 2].