Narrowing of the aortic valve, which is the valve through which you push blood from the heart to the rest of the body, is quite common in older people. After the ages of 70-75, 5-10% of people develop degenerative stenosis of this valve due to use, and over time it is the most common valvular disease requiring surgical replacement.

In 2007, its innovative and revolutionary for the time percutaneous replacement was applied. With this method, the valve is implanted with a catheter from the femoral artery, without incisions and general anesthesia, like the well-known coronary angiography. The percutaneous replacement is clearly simpler for the patient with much less risk and discomfort than the classic surgery and with an immediate return to everyday life.

This year marks 16 years since the application of the method worldwide and in Greece. In addition to the obvious advantages, the continuous technological improvements as well as the very good results of the method have led to its impressive spread. For years now it has been the dominant treatment for aortic stenosis in developed countries. It seems that in the medical community the debate has shifted from which patient should be selected for percutaneous replacement in the past to who should be selected for the classic surgical method today.

It is not only the much simpler and safer nature of the method, with rapid recovery and obvious socio-economic advantages that have led to this conversion, but also the long-term results of the method compared to surgery. Very favorable 5-year long-term comparative results have recently been announced in typical patients with aortic stenosis, and not only in elderly, inoperable and high-risk patients where the method was originally applied and proven. The percutaneous method was as effective as, if not superior to, classical surgery in every field of comparison, which explains the tendency to apply it universally when feasible.

However, the advantages are not limited to the patient, which is of course the main concern of all of us, but also extend to society. The minimally invasive nature of the treatment allows for the minimization of the duration and intensity and thus the cost of hospitalization with an immediate return to productive everyday life, minimizing the family and collective burden. The trend worldwide is for these patients to stay in the hospital for only two days.

Virtually all of the initial individual ambiguities or concerns about the percutaneous method have been cleared up. It has now been proven that, compared to surgery, the risk of arrhythmias, stroke, bleeding, vascular, neurological and nephrological complications is lower with the percutaneous method.

And in our country, its application is expanding satisfactorily, but it falls far short of the countries of western, central and many of eastern Europe, as well as Cyprus. In terms of design, there are two types of percutaneous aortic valves today, balloon-expandable and self-expanding flap properties, and depending on the clinical and anatomical characteristics of each patient, the most appropriate one is selected.

The rapid development and spread of percutaneous treatments for the rest of the heart valves is a fact. In addition to clips for the mitral and tricuspid valves, there are and we now use percutaneous valves for the complete replacement of these valves as well. But the long-term experience of percutaneous aortic valve replacement with exhaustively detailed and continuous evaluations is unparalleled and has led to such a degree of confidence that it leads us to recommend it to the majority of patients.

No one would want to subject the patient to the inconvenience of surgery for a bioprosthetic aortic valve when this is possible percutaneously with fewer complications and at least comparable long-term results. How much more so when this is also beneficial with social/economic criteria.

No doubt percutaneous treatments for all heart valve diseases will continue to evolve technologically, further simplifying what we already use today. The setting for the younger people who will develop valvular diseases in the future will be completely different from what we have known until now, as is the case with most human diseases!

Facts:

  • The first percutaneous aortic valve implantation was performed in 2002 by French cardiologist Alain Cribier and the valve became clinically available in 2007.
  • The first percutaneous aortic valve implantation in Greece was performed by the undersigned in 2007.
  • The first percutaneous mitral clip procedure was performed in 2004 by German Cardiologist E Grube and the Mitraclip became clinically available in 2008.
  • The first percutaneous mitral clip operation in Greece was performed by the undersigned in 2011.
  • In 2022 approximately 1,200 patients were treated with percutaneous aortic valve replacement in Greece.
  • In 2022 approximately 140 patients were treated with a mitral or tricuspid clip in Greece.