Transcatheter Mitral Valve Replacement: An Update on the Current Literature

The purpose of this review was to evaluate the complexities and challenges associated with transcatheter mitral valve replacement and review the existing data.

Many patients with mitral valve disease are not candidates for cardiac surgery and are in need of less invasive transcatheter therapies. The first transcatheter mitral valve replacement (TMVR) in a native valve was performed in 2012. However, the complexities and variability of the mitral valve anatomy and its relationship to neighboring structures have resulted in slower progress with this new therapy compared to the rapid uptake that has occurred with transcatheter aortic valve replacement. TMVR can be applied to degenerated prosthetic valves and annuloplasty rings or to a wide variety of native mitral valve disease. In cases of degenerated bioprosthetic valves, annuloplasty ring, and native valve mitral annular calcification, transcatheter heart valves (THVs) designed for the aortic position can be implanted with high procedural safety and success rates. In the case of native valve mitral regurgitation, the complexities have led to the development of several TMVR systems for native valve disease with different anchoring mechanisms and geometry; all are currently investigational and none are FDA approved at this time. It is clear from the initial experience with TMVR that careful patient selection and pre-procedural planning are necessary to maximize benefit and avoid complications. TMVR is an exciting complex therapy offering promise for patients who cannot be treated with existing techniques. The key to success will be a combination of appropriate patient selection, careful comprehensive pre-procedural planning, rising new technologies, as well as further research to appropriately define and mitigate the risks associated with the procedure.