What is percutaneous valve replacement procedure?
A percutaneous valve replacement is a minimally invasive procedure to replace a diseased heart valve. The malfunctioning valve is removed and replaced with a manufactured valve, which may be mechanical. Other valve replacements may be crafted from animal tissue, or human tissue harvested from the patient’s own membrane enveloping the heart (pericardium).
A flexible tube (catheter) carries the valve to the heart through blood vessels, and then deploys the valve in place. The catheter may be inserted
- through the ribs into the apex of the heart (transapical),
- an artery in the wrist (transradial),
- neck (transjugular), or the
- groin (transfemoral).
The cardiologist uses ultrasonography and continuous X-ray (fluoroscopy) images for guidance.
Developments in percutaneous heart valve replacement
Percutaneous repair and replacement of heart valves is currently a developing field. While repair and balloon dilation of heart valves (valvuloplasty) are being performed extensively now, many of the valve replacement devices and techniques are still in developmental stages.
Currently, percutaneous valve replacement is performed only on patients who are at high risk for open heart surgery. Studies are ongoing to make it available as a less-invasive option to low-risk patients.
The heart has four valves that regulate the blood flow:
- Aortic valve between the left ventricle and aorta
- Mitral valve separating left atrium and left ventricle
- Pulmonary valve between right ventricle and pulmonary artery
- Tricuspid valve separating right atrium and right ventricle
Current stages of development in percutaneous replacement of the four heart valves are as follows:
Aortic valve
Percutaneous aortic valve replacement/implantation (PAVR/PAVI) also known as transcatheter aortic valve replacement/implantation (TAVR/TAVI) is a well-established treatment under certain conditions. Balloon valvuloplasty is widely performed as a temporary treatment for aortic calve narrowing (stenosis).
Mitral valve
Percutaneous balloon valvuloplasty is widely performed to dilate the mitral valve, but other procedures are in testing and clinical trial phases. Percutaneous mitral valve repair has been performed only in clinical trials, while percutaneous replacement is yet to be performed on humans.
Pulmonary valve
Clinical experience in percutaneous pulmonary valve replacement is the largest among all percutaneous valve replacements. Pulmonary valve replacement is performed primarily for congenital heart disease.
Tricuspid valve
At present percutaneous tricuspid valve repair procedure is under clinical trials and valve replacement is in early stages of development.
Why is percutaneous valve replacement performed?
Percutaneous procedure is a minimally invasive procedure for patients with serious heart valve disease who are elderly or those with significant other coexisting conditions (comorbidities) that preclude open surgery.
Currently, only aortic and pulmonary valve replacements are performed percutaneously. Only valve repairs and dilatation are percutaneously performed in the mitral and tricuspid valves.
Percutaneous valve replacement is performed to treat the following conditions:
- Backflow of blood from the aorta into the left ventricle (aortic regurgitation) due to
- Deterioration of the valve
- Bacterial infection (endocarditis)
- Obstruction of blood flow due to aortic valve stenosis
- Congenital heart disease with malformed aortic valve that leads to regurgitation or obstruction
- Pulmonary hypertension and dysfunctional pulmonary valve that results in pulmonary regurgitation
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