Percutaneous valve repair and replacement: challenges encountered, challenges met, challenges ahead.

Percutaneous valve therapy developed initially with aortic valve replacement, described by Andersen et al3 in 1992 in a swine model. These investigators fabricated a stent-mounted bioprosthetic valve and demonstrated that percutaneous implantation is feasible. Bonhoeffer et al4 reported the use of a stent-mounted bioprosthesis for pulmonic valve replacement in 2000. This achievement clearly marked the beginning of the era of percutaneous valve replacement therapy in patients. Pulmonic valve replacement with this percutaneous approach has been remarkably successful. To date, 100 patients have been treated, with only a single procedure-related mortality and good results in a population of pediatric patients with congenital heart disease who otherwise would face third or fourth open heart procedures. Percutaneous aortic valve replacement with a stent-mounted bioprosthetic valve device was initially reported by Cribier et al5,6 in 2002, with a growing experience since then.