Heart valve diseases are becoming increasingly common and require new treatment approaches. Michiel Voskuil, Professor of Percutaneous Treatment of Heart Disease, sees great potential in minimally invasive procedures in which heart valves are replaced through a catheter inserted via the groin. On March 13, he delivered his inaugural lecture, titled ‘The Whole Heart’, in which he calls for continued innovation in the treatment of structural heart disease.
According to Michiel, cardiology has undergone tremendous change over the past decades. Treatments that once required major surgery can now often be performed using catheter-based techniques. He emphasizes that treatment in the cardiac catheterization laboratory is no longer limited to angioplasty procedures. Today, cardiologists can treat or replace all four heart valves using minimally invasive techniques. These procedures are also less burdensome for patients and typically allow for faster recovery compared with open-heart surgery.
In his lecture, Voskuil describes two patients who illustrate how much cardiac care has evolved.
The first patient is a 60-year-old man with a congenital heart defect. At a young age he underwent surgery in which his aortic valve was replaced. Years later, another valve deteriorates. Instead of undergoing another open-heart operation, the valve can now be replaced through a catheter procedure via the groin.
The second patient is also a 60-year-old man who develops symptoms later in life due to a severely worn aortic valve. Because of previous radiation therapy for cancer, open-heart surgery carries too high a risk. For him as well, a new valve can be implanted through the groin using a procedure known as TAVI. According to Voskuil, this development clearly shows how innovation is transforming cardiology. “Replacing a heart valve through the groin is a prime example of medical innovation that has demonstrably delivered major benefits for patients.”
These developments come at a time when heart valve disease is becoming increasingly common. As Voskuil noted in his inaugural lecture, “Heart valve diseases represent a significant and growing health problem, particularly in our ageing society.” Around 2.5 percent of adults have a heart valve condition. Among people over the age of eighty, this increases to more than one in eight. As the population ages, demand for treatment is expected to continue to rise.
At the same time, the number of adults living with congenital heart disease is growing. Thanks to improved treatments, more children with congenital heart defects now survive into adulthood. However, they often require specialized care throughout their lives.
Despite the progress made, Michiel believes there is still considerable room for improvement. At UMC Utrecht, extensive research is therefore being conducted to make heart valve treatments safer and more effective. For example, researchers are studying ways to reduce complications during valve interventions, such as lowering the risk of stroke during procedures. Several studies are also examining the optimal timing of valve replacement and the development of new types of valve prostheses. One example is the national PRO-TAVI study, in which UMC Utrecht collaborates with other Dutch hospitals to investigate whether patients with both a narrowed aortic valve and coronary artery disease benefit from angioplasty before undergoing TAVI. The study aims to determine the most effective treatment strategy for these patients. Michiel is also a co-initiator of other research initiatives, such as the new HYCORE study, partially funded by the Dutch Heart Foundation, in which researchers from various centers in Denmark, Belgium, and the Netherlands collaborate on innovative treatment strategies for patients with narrowing in multiple coronary arteries.
By combining clinical expertise, technological innovation and collaboration between research groups, Michiel hopes to contribute to increasingly personalized cardiac care. In the future, patient data and advanced imaging may help determine the most suitable treatment for each individual patient.
Care for patients with structural heart disease requires close collaboration between different specialties, including cardiac surgery, anesthesiology, geriatrics, radiology, and pediatric cardiology. According to Michiel, such collaboration is essential to ensure that innovation ultimately benefits patients. As he puts it: “If there is one thing I have learned over the past years in clinical practice and scientific research, it is that collaboration is key; one plus one really does equal three.”
The two patients with whom he began his lecture illustrate why continued innovation in cardiac care is so important. Although their backgrounds are very different, a congenital heart defect in one case and a defective heart valve later in life in the other, both benefit from the same technological advances in cardiology. New minimally invasive treatments now make it possible to help patients who previously could only be treated with major surgery, or who sometimes had no treatment options at all.
Through continued innovation and collaboration, Michiel hopes to further improve care for patients with heart disease in the years ahead: moving from treating individual valves to caring for the whole heart.
