Valvular heart disease: when does surgery remain the best option?

Surgical treatment remains the cornerstone of valvular heart disease (VHD) treatment1. Surgery was the only option for all types of VHD until 1984 when the first report of transseptal percutaneous mitral balloon commissurotomy (PMC) in mitral rheumatic disease was published2,3. Shortly after followed the first report of balloon aortic valvuloplasty by Cribier and colleagues4. Some time later, first-in-man reports were successively published on transcatheter aortic valve implantation in 2002 and mitral edge-to-edge repair in 2004, followed more recently by mitral bioprosthetic replacement and tricuspid repair5,6,7,8. Nowadays, PMC is an established routine treatment for rheumatic mitral stenosis (more than 20 years of experience)9. With ...