Percutaneous interventions for mitral and tricuspid heart valve diseases

Percutaneous mitral and tricuspid valve interventions are alternative treatment options for patients who are deemed to be at high surgical risk and/or inoperable. Transcatheter edge-to-edge mitral valve repair using the MitraClip and PASCAL system, which are designed to mimic the surgical Alfieri's stich, has changed the landscape for the treatment of symptomatic functional mitral regurgitation (MR). Previous studies have shown that the procedure can reduce symptoms and improve functional capacity with low rates of complication. Recently, two randomized controlled clinical trials have reported the effect of the MitraClip on outcomes for secondary MR. Next-generation devices, advanced techniques, and additional clinical data would further improve the outcomes following this procedure. Percutaneous direct annuloplasty using the Cardioband system is a relatively new technique that closely resembles surgical annuloplasty. Its role in treating secondary MR as well as its concomitant use with edge-to-edge mitral repair will continue to gain attention. The transapical off-pump mitral valve repair with neochord implantation, known as a NeoChord procedure, is also a new option to implant artificial chords in a minimally invasive manner in MR patients with leaflet prolapse or flail. Transcatheter mitral valve replacement is another emerging treatment option for selected patients. Although the development of transcatheter strategies for tricuspid regurgitation (TR) is still in the early stages, there is growing evidence to support the application of various approaches, including edge-to-edge repair and annuloplasty, to address unmet needs. In this review article, we will summarize the emerging minimally invasive interventions for mitral and tricuspid valves.