Transcatheter Mitral Valve Implantation
Mitral regurgitation (MR) is the most common cardiac valve pathology in Western countries, with an estimated prevalence of moderate and severe MR in the USA of 2–2.5 million. Though surgical valve repair and replacement are the current gold standard treatment for significant MR, surgery can be associated with significant morbidity and even mortality. This fact and the desire for less invasive approaches have led to the development of a variety of percutaneous approaches to treat MR. New transcatheter mitral repair technologies, such as the MitraClip™ system and other transcatheter devices using the concepts of annuloplasty, chordal implantation, or left ventricular (LV) remodeling, may offer a less invasive alternative to conventional surgery. However, these approaches have their own drawbacks, including failure to eliminate MR completely. Transcatheter mitral valve implantation (TMVI), in contrast, has the potential to reduce MR to a similar extent as that achieved with surgery, with the potential for reducing invasiveness and procedural risk. The first-in-human percutaneous TMVI for native mitral valve regurgitation was performed in 2012. Since then, several medical device companies have been attempting to bring suitable transcatheter valves to the market. This chapter aims to introduce the transcatheter MV implantation (TMVI) devices currently being evaluated in human trials.
KeywordsMitral valve regurgitation Mitral valve stenosis Transcatheter mitral valve implantation Transcatheter mitral valve repair Mitral valve surgery
- 9.Vahanian A, Alfieri O, Andreotti F, et al. Guidelines on the Management of Valvular Heart Disease (version 2012). The joint task force on the management of Valvular heart disease of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). Giornale Italiano di Cardiologia (2006). 2013;14:167–214.Google Scholar
- 17.Seeburger J, Rinaldi M, Nielsen SL, Salizzoni S, Lange R, Schoenburg M, Alfieri O, Borger MA, Mohr FW, Aidietis A. Off-pump transapical implantation of artificial neochordae to correct mitral regurgitation: the TACT trial (Transapical artificial chordae Tendinae) proof of concept. J Am Coll Cardiol. 2014;63:914–9.CrossRefPubMedGoogle Scholar
- 19.Blanke P, Naoum C, Webb J, Dvir D, Hahn RT, Grayburn P, Moss RR, Reisman M, Piazza N, Leipsic J. Multimodality imaging in the context of transcatheter mitral valve replacement: establishing consensus among modalities and disciplines. JACC Cardiovasc Imaging. 2015;8(10):1191–208.CrossRefPubMedGoogle Scholar
- 20.Ussia GP, Quadri A, Cammalleri V, De Vico P, Muscoli S, Marchei M, Ruvolo G, Sondergaard L, Romeo F. Percutaneous transfemoral-transseptal implantation of a second-generation CardiAQ™ mitral valve bioprosthesis: first procedure description and 30-day follow-up. EuroIntervention. 2016;11(10):1126–51.CrossRefPubMedGoogle Scholar