A Tale of Two Valves

Two percutaneous heart valve procedures have been introduced recently, the Transcatheter Aortic Valve Implantation (TAVI) and the mitral clip, both still investigational devices. One promises a solution to a very difficult problem, the other doesn’t.

TAVI is presently researched for select patients with severe symptomatic aortic stenosis (narrowing of the aortic valve opening) who are not candidates for surgery and those who are at very high risk:

The mitral valve clip has been developed for use in some patients with mitral insufficiency:

TAVI is associated with an acceptable mortality and morbidity risk, particularly if it continues to be used only in patients who are not candidates for traditional aortic valve replacement. Its limitations include size (neither too big or too small) and higher stroke and heart block rates in comparison with traditional aortic valve replacement techniques. If the initial studies hold true, TAVI promises a solution for the 30% of patients with aortic stenosis who presently would be inoperable.

The Mitral clip procedure on the other hand doesn’t seem to offer any advantage over a standard mitral valve repair. It is also associated with a much higher mortality and a high rate of continued leakage and consequent need of conversion to surgery anyway.

I suspect that these devices will be eventually promoted as a way to avoid painful and dangerous open-heart surgery, and that the original indications for use only in highly selected patients will be diluted to a much wider population.

Please tell me what you think,

Dr T



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