Percutaneous therapy for valvular heart disease: a huge advance and a huge challenge to do it right.

In this week’s Circulation, Webb and colleagues1 report on the use of percutaneous “valve-in-valve” rereplacement in the treatment of 24 ill patients with prosthetic valve failure under compassionate-use protocols. Ten procedures addressed the aortic valve; 7, the mitral valve; 6, the pulmonary valve; and 1, the tricuspid valve. The 30-day survival rate was 96%. Clinically, the results were excellent, with 88% of these highly symptomatic patients returning to New York Heart Association class I or II. Hemodynamically, the results were more modest, with an average postprocedure transaortic gradient of 20 mm Hg and a transmitral gradient of 8 mm Hg.