Transcatheter mitral valve interventions: current status and future perspective (original) (raw)
Related papers
Transcatheter mitral valve regurgitation treatment: State of the art and a glimpse to the future
The Journal of thoracic and cardiovascular surgery, 2016
Since the first transcatheter heart valve implantation in the pulmonary position in 2000 and in the aortic position in 2002, a large number of transcatheter heart valves have reached the clinical arena and thousands of high-risk patients have been treated successfully, in particular those with severe aortic stenosis. In contrast, the experience of transcatheter mitral valve repair or implantation started relatively more recently, and only a few devices are available at the moment. The aim of this review is to describe the different percutaneous systems for the treatment of mitral regurgitation.
Clinical trial experience with the MitraClip catheter based mitral valve repair system
The International Journal of Cardiovascular Imaging, 2011
Severe mitral regurgitation (MR) confers a poor prognosis, in particular for patients with heart failure. Based on the results of the Euro Heart Survey, a large proportion of patients with mitral regurgitation is not referred to surgery and many other patients are rejected for cardiac surgery due to the high surgical risk or co-pathologies. Improving ventricular function with ACE inhibitors, beta-blockers and CRT may reduce mitral regurgitation, but for most patients a mechanical intervention is ultimately preferable. Mitral valve surgery is invasive and requires a long recovery period; therefore, less invasive and effective approaches are highly desirable, particularly in high risk patients. Therefore, new techniques have been recently developed to treat MR with percutaneous approach. The MitraClip device (Abbott Vascular, Menlo Park, CA) is used to treat both functional and degenerative mitral valve regurgitation. Its safety and efficacy has been initially tested in the Endovascular Valve Edge-to-Edge REpair Study (EVEREST), while MitraClip has been compared to surgery in the EVEREST II randomized trial. Besides EVEREST trials, safety and efficacy of the device as well as its health economic value is under evaluation in ongoing registries. Although the field of catheter based management of MR is at an early stage, initial clinical results have demonstrated that catheter based approaches can reduce MR, suggesting there is a great deal of potential for clinical benefit to patients with MR.
Percutaneous "edge-to-edge" leaflet repair in patient with primary mitral valve regurgitation
Mini-invasive Surgery , 2020
Mitral regurgitation (MR) is the most common left-sided heart valve disease in developed countries with a constantly rising number of patients requiring hospitalization or intervention. Organic MR is defined as a primary structural abnormality of the mitral valve (MV) apparatus which may be caused by a broad set of pathological processes, among which myxomatous degeneration of the leaflets causing MV prolapse is the most common. If left untreated, chronic severe MR leads to serious adverse outcomes, from heart failure to death, but medical therapy is unable to change the natural history of the disease. Surgical correction, by means of valve repair or replacement, is the gold standard for the treatment of symptomatic patients with severe primary MR. However, surgery is not feasible for a large percentage of patients because of old age, reduced left ventricular ejection fraction and the presence of severe comorbidities. Therefore, in recent years, several percutaneous therapeutic alternatives suitable for high or prohibitive surgical risk patients were developed. In this review we discuss the transcatheter treatment of primary MR, from available evidence to technical practice, with a focus on the percutaneous "edge-to-edge" leaflet repair performed with the MitraClip System and the PASCAL Repair System.
Percutaneous Mitral Valve Repair with the MitraClip System in the Current Clinical Practice
Hearts, 2021
Severe mitral valve regurgitation (MR) carries a significant burden both in prognosis and quality of life of patients, as well as on healthcare systems, with high rates of hospitalization for heart failure. While mitral valve surgery constitutes the first-line treatment option for primary MR in suitable patients, surgical treatment for secondary severe MR remains controversial, with a substantial lack of evidence on a survival benefit. In recent decades, percutaneous mitral valve repair has emerged as an alternative treatment for patients deemed not suitable for surgery. Among several devices under development or evaluation, the MitraClip system is the most widespread and is supported by the strongest evidence. While the role of MitraClip in patients with chronic primary MR who are not deemed suitable for surgery is well established, with consistent data showing improvement in both prognosis and quality of life, MitraClip treatment in secondary MR is a rapidly evolving field. Two re...
Current Percutaneous Approaches to Treat Mitral Valve Regurgitation
Current Treatment Options in Cardiovascular Medicine, 2024
Purpose of review In recent years, our understanding of mitral regurgitation and its management has evolved substantially. In particular, as percutaneous mitral valve interventions have proven safe and effective, it has become possible to offer expanded therapeutic options to patients who are deemed inoperable or at high surgical risk. This review provides an overview of currently available transcatheter mitral valve interventions and summarizes recently published findings that may allow for better risk stratification, patient selection, and procedural safety and efficacy. Recent findings In the last 1-2 years, numerous studies have provided important insights that help to better characterize patients in clinical practice and to select them more optimally for specific interventional mitral valve procedures. Summary The evolution of percutaneous MV therapy has been substantial and extremely beneficial for patient care. Nonetheless, this is an area underdevelopment and newer or enhanced devices are likely to emerge in the future.
New Transcatheter Mitral Valve Treatment
Interventional Cardiology Review, 2011
Percutaneous treatment of severe mitral regurgitation is a very interesting therapeutic option for those patients considered not to be suitable candidates for surgery. Different technologies have already demonstrated proof-of-concept, and one of these devices (the Mitraclip device) has already obtained the Conformité Europeéne mark. However, demonstrating safety and efficacy for most of these technologies is being harder than anticipated. Recently, research and development has become more compromised due to the financial crisis. This paper reviews the venues that are currently under evaluation.
Mitral valve therapy still surgical?
European Heart Journal Supplements, 2015
Mitral regurgitation (MR) is the second most common valvular heart disease after aortic valve stenosis. With increased understanding of the heterogenic pathophysiology of MR, cardiac surgeons have developed various techniques that increase the likelihood of successful mitral valve repair (MVR). Nowadays, a rate of repair .90% may be reached in some mitral valve reference centres. In recent years, the introduction of transcatheter mitral valve intervention techniques has opened up new frontiers in mitral therapy, specifically in patients at high risk for standard surgery. Current percutaneous technologies for MVR have been developed on the basis of some of the surgical principles. Based on current evidence, surgery remains the standard treatment for MR according to very long-term survival and durability of MVR using Carpentier's technique. Today, in clinical practice, only the MitraClip device may be considered as a real and effective alternative in selected patients with high or prohibitive risk for surgery.
Emerging Technologies for Percutaneous Mitral Valve Repair
Frontiers in Cardiovascular Medicine, 2019
Mitral regurgitation (MR) is a common disease affecting more than 4 million people in the United States and the European Union. A significant number of percutaneous valves have been developed recently, specifically designed for the mitral anatomy, and with a promising evidence of good procedural and echocardiographic outcomes. However, even if transcatheter mitral valve replacement (TMVR) will have a role in the future of percutaneous treatment of both functional and degenerative mitral regurgitation, percutaneous mitral valve repair will always play a vital role in the treatment of MR because of the favorable safety profile and the fact that it respects the native anatomy. In this review, we will discuss the new emerging technologies under development to treat mitral regurgitation focusing on different devices that aim to target different components of the mitral anatomy.
Advances in Interventional Cardiology
There is a worldwide expansion in percutaneous therapy for valvular heart disease. Rapidly evolving technology and the general increase in life expectancy will support the evolution of new treatment options dedicated to structural heart interventions. Transcatheter aortic valve implantation for severe aortic valve stenosis and percutaneous mitral valve repair with the MitraClip system for severe mitral regurgitation have been demonstrated as a feasible, innovative alternative for surgical treatment. Despite the inequality in clinical experience, both procedures have encouraging results and now are a part of everyday clinical practice. More importantly, rapid development is expected in the next decades. However, the global coronavirus disease 2019 (COVID-19) pandemic imposed redistribution of healthcare resources. Hospitals were obliged to modify their workflow and limit TAVI and MitraClip procedures to urgent or in highly symptomatic patients. Despite this encumbrance improvement in technology and experience supported by robust evidence from current studies might extend indications for both procedures. The future holds promise for this treatment modality to become the preferred procedure for all patients despite age or risk and reserving surgical treatment for a minority. Thus, we present state-of-the-art and current evidence for both methods assumed to change the paradigm of treatment of valvular heart failure in the future.