ABSTRACT
Introduction An increasingly sophisticated understanding of basic biologic science and continuing innovation in biomedical technology will continue to shape the evaluation and treatment of patients with valvular heart disease (VHD). In many instances, distinct technologies are competing to serve the same clinical purpose. Predicting which of these will prevail is difficult. The adaptation of new techniques and devices is determined by many factors, including efficacy, safety, cost, convenience, regulatory approval, ease of integration with existing technology, and timing of arrival on the market. Government regulators will play an important role. They must negotiate between the demand to provide access to new life-saving or life-improving technology and the obligation to protect the public from therapy that may have rare or very late-onset but grave complications. Finally, even the wealthiest societies will be unable to afford every advance in biomedical technology. Cost-effectiveness analysis will likely play an increasingly important role in government and private insurance coverage decisions. Obviously, those developments that both improve outcomes and save money will dominate. In this chapter, recent developments will be reviewed (Rahimtoola, 2005) and their implication for future clinical care will be considered.
