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A Simplified Stepwise Approach to Echo Guidance during Percutaneous Mitral Valve Repair
Published on: October 16, 2021
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Transcatheter Mitral Valve Replacement: Procedural Planning, Utility, and Applicability.
Sophia L Alexis1, Aditya Sengupta1, Syed Zaid2
1From the Department of Cardiovascular Surgery, Mount Sinai Medical Center, New York, NY.
Cardiology in Review
|September 17, 2020
Summary
Transcatheter mitral valve replacement (TMVR) offers new hope for mitral valve disease. Careful planning and patient selection are key to successful TMVR, expanding treatment options beyond surgery.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Devices
Background:
- Transcatheter mitral valve replacement (TMVR) has evolved since 2012, addressing degenerated bioprostheses, failed annuloplasty rings, and mitral annular calcification.
- High screen failure rates in TMVR trials persist due to concerns like left ventricular outflow tract obstruction and complex patient anatomy.
Purpose of the Study:
- To review the current landscape and future directions of transcatheter mitral valve replacement (TMVR).
- To highlight the importance of preprocedural planning and patient selection for successful TMVR outcomes.
Main Methods:
- Preprocedural planning utilizing multidetector computed tomography (MDCT) and transesophageal echocardiography (TEE) is crucial.
- TMVR approaches include transseptal, transapical, and transatrial routes, chosen based on patient candidacy and anatomy.
Main Results:
- TMVR shows the most significant benefit in cases of native mitral regurgitation and degenerated bioprostheses.
- Outcomes for failed annuloplasty rings and mitral annular calcification are less consistently favorable compared to other indications.
Conclusions:
- Technological advancements and meticulous patient selection are vital for expanding TMVR applications.
- TMVR is poised to become a valuable complement to surgical interventions and transcatheter mitral valve repair for a wider range of mitral valve diseases.
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