The number of valve surgeries is increasing with a change in the disease structure from rheumatic valvular heart disease （VHD） to arteriosclerotic or degenerative VHD. The treatment strategies for VHD have also been changing over the last two decades. Repair techniques for valve regurgitation have been established with excellent long-term clinical results. As valve repair has advantages over prosthetic valve replacement in terms of avoidance of anticoagulation and reduced risk of valve infection, it has become the first choice for treatment of degenerative VHD even for infective endocarditis, which is closely related to dental caries, periodontal disease, and related dental procedures. With the development of technologies, minimally invasive cardiac surgery is evolving, including the introduction of video-assisted or robotically-assisted valve surgeries via minithoracotomy, or percutaneous transcatheter therapies. Notably, recently introduced transcatheter aortic valve replacement has shown excellent clinical results compared to surgical aortic valve replacement and has become a standard therapy for aortic stenosis in the elderly. Reoperative aortic valve replacement for a degenerated bioprosthetic valve can also be performed using the transcatheter “valve in valve” technique. These minimally invasive approaches are likely to become more widely adopted and may determine the scope of therapeutic strategies for VHD into the future.
