Innovations in Structural Heart Disease Management

Review Paper | 2026 | Volume 2 | Issue 1 | Page 67 - 72

Dr. SK Singh, Assistant Professor, Department of Cardiology, BSMCH, Bangladesh

Abstract

Innovations in Structural Heart Disease Management.

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The management of structural heart disease (SHD) has undergone a seismic shift, moving from highly invasive surgical repairs to sophisticated, catheter-based interventions. While Transcatheter Aortic Valve Replacement (TAVR) served as the proof-of-concept for this revolution, recent innovations have extended these "NextGen" therapies to the mitral, tricuspid, and pulmonic valves, as well as the left atrial appendage. This chapter provides a comprehensive overview of the Innovations in SHD Management, focusing on the transition from "replacement-only" strategies to complex "repair" and "remodeling" techniques. We examine the clinical efficacy of Transcatheter Edge-to-Edge Repair (TEER) for mitral and tricuspid regurgitation, utilizing the latest data from the COAPT and TRILUMINATE trials. A primary focus is placed on Transcatheter Mitral Valve Replacement (TMVR) and the engineering challenges of anchoring prostheses within the non-circular, dynamic mitral annulus. Furthermore, the discussion explores Left Atrial Appendage Occlusion (LAAO) as a non-pharmacological alternative to anticoagulation for stroke prevention in atrial fibrillation. The chapter also highlights the critical role of 4D-Echocardiography and CT-Fluoroscopy Fusion Imaging in navigating the complex intra-cardiac anatomy. By synthesizing data from 2024–2026 registries, this chapter illustrates how SHD management now prioritizes "Minimalist" workflows and "Lifetime Patient Pathways." This evolution marks the end of the "one-size-fits-all" surgical era, ushering in a period of personalized, heart-team-led structural interventions that minimize recovery time while maximizing hemodynamic durability.