Structural interventions, including ventricular remodeling, for dilated ventricles and valvular heart disease (VHD), show promise in the management of structural cardiac abnormalities that may be resistant to traditional guideline-directed medical therapies, according to a JACC scientific statement published Aug. 19.  

Rebecca T. Hahn, MD, FACC, et al., review the current percutaneous strategies for treating dilated left ventricular (LV) cardiomyopathies and VHD, first focusing on different types of device-based therapies for physical reverse remodeling, the process of making the ventricular chamber smaller to reduce wall stress. They note that percutaneous ventricular reshaping and partitioning devices can change the shape, size or mass of the LV or eliminate dysfunctional portions. In addition, interatrial shunts can reduce exercise pulmonary capillary wedge pressure.  

Hahn et al., also include significant discussions on the outcomes for aortic, mitral and tricuspid valve interventions for different conditions and considerations, including aortic stenosis and regurgitation, cardiac amyloidosis, rheumatic or calcific mitral stenosis, mitral annular calcification, and more. They pull from a wide body of literature and studies, paying special attention to the COAPT trial on the use of transcatheter edge-to-edge repair for mitral regurgitation.  

“These outcomes underscore the need for ongoing aggressive medical management of patients treated for structural causes of [heart failure], but also raises a question of optimal interventional timing.” The authors conclude. “The appropriate timing of structural heart interventions depends on a comprehensive understanding of procedural risks/benefit and durability of these devices.”   

That comprehensive understanding is slowly being created: “For many of these devices, ongoing trials may help answer these questions and allow us to integrate these therapies into the management algorithm for patients with HF.”  

JACC Editor Emeritus Valentin Fuster, MD, PhD, MACC, praised the scientific statement, saying, “I have to congratulate the authors of this document for a very up-to-date approach of a very important subject.”  

Clinical Topics: Heart Failure and Cardiomyopathies, Valvular Heart Disease, Acute Heart Failure, Mitral Regurgitation

Keywords: Cardiomyopathies, Aortic Valve Stenosis, Heart Failure, Heart Valve Diseases, Mitral Valve Stenosis, Ventricular Remodeling, Pulmonary Wedge Pressure, Tricuspid Valve, Mitral Valve Insufficiency