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Review articles

Transcatheter mitral valve interventions: current status and future perspective

NorthShore University HealthSystem, Evanston, IL, USA

Aims: With the recent developments in the field of transcatheter aortic valve replacement for aortic stenosis there has been a similar advance in the field of transcatheter mitral valve therapy for mitral regurgitation (MR). Both the anatomy of the mitral apparatus and the spectrum of pathology of MR are more complex than for aortic valve disease, and thus the development of MR therapies has been more complicated and less rapid.

Methods and results: The purpose of this review of recent literature is to provide a synopsis of the present technologies under development for percutaneous therapy for MR. Leaflet repair with MitraClip has accrued the largest human experience among the technologies that are under development, having been used to treat over 6,000 patients. MitraClip is currently being used in patients with functional MR and at high risk for conventional surgery. Coronary sinus, or indirect annuloplasty, has the next largest clinical experience, with several hundred patients treated in trials. Other MR therapy devices, including several direct annuloplasty approaches, mitral valve replacement prostheses, and chordal replacement devices, are still in the earlier phases of development.

Conclusions: The early technological advances have not only enhanced our understanding of the complex interplay of different components of the mitral valve apparatus but also promise continued refinement in our present modalities of treatment and improved clinical outcomes for future patients.

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