Current Devices and Complications Related to Transcatheter Mitral Valve Replacement: The Bumpy Road to the Top

Abstract

Mitral regurgitation is the most common valvular lesion in the developed world, with increasing prevalence, morbidity, and mortality. The experience with surgical mitral valve repair or replacement is very well-validated. However, more than 45% of these patients get denied surgery due to an elevated risk profile and advanced disease of the left ventricle at the time of presentation, promoting the need for less invasive transcatheter options such as transcatheter repair and transcatheter mitral valve replacement (TMVR). Early available TMVR studies have shown promising results, and several dedicated devices are under clinical evaluation. However, TMVR is still in the early developmental stages and is associated with a non-negligible risk of periprocedural and post-procedural complications. In this review, we discuss the current challenges facing TMVR and the potential TMVR-related complications, offering an overview on the measures implemented to mitigate these complications, and future implications.

Imaging in transcatheter native mitral valve replacement with Tendyne mitral valve system: Echocardiographic pathway for the interventional imager

“…Mitral regurgitation represents an important health care burden and its treatment is still a challenge in clinical arena [3,4]. Mitral valve (MV) surgery plays a primary role on indications for intervention, however, transcatheter procedures have emerged as an alternative option to treat inoperable and high-risk surgical patients and have been impressively expanding [3,[4][5][6][7][8][9][10][11][12][13][14][15]. This growth has been possible thanks to the developments and rapid progress of new percutaneous devices but also due to the innovations in imaging techniques [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24].…”

“…Mitral valve (MV) surgery plays a primary role on indications for intervention, however, transcatheter procedures have emerged as an alternative option to treat inoperable and high-risk surgical patients and have been impressively expanding [3,[4][5][6][7][8][9][10][11][12][13][14][15]. This growth has been possible thanks to the developments and rapid progress of new percutaneous devices but also due to the innovations in imaging techniques [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24]. These developments have prompted the need for a new dedicated professional figure with specific competencies in the field of structural heart disease procedures imaging 'the interventional imager' whose collaboration with the implanter team is crucial for the procedural success [22,25,26].…”

“…The transcatheter edge-to-edge mitral leaflet repair transcatheter edge to edge repair (TEER) is the most frequently applied interventional procedure in MV therapeutic strategy, however, some anatomic substrates are not suitable (e.g., cleft or perforation, previous mitral valve repair, mitral annulus calcification, leaflet thickening and calcification in particular in the grasping areas, short posterior mitral leaflet with limited motion, rheumatic heart disease) as well as the repair is not always able to both fully correct the severity of the regurgitation and prevent MR progression overtime [3,[5][6][7][8][9][10][11][12][13][14][15]. Transcatheter native mitral valve replacement (TMVR) is a novel procedure that has the potential to overcome some of the current limitations associated with the transcatheter edge-to-edge mitral valve repair technique [4][5][6][7][8][9][10][11][12][13][14][15]. Imaging is paramount in planning and guide the MV interventional procedure.…”

“…Nowadays there is a wide range of TMVR devices at various stages of development [5][6][7][8][9][10][11][12][13][14][15][27][28][29]. We will focus our review on the Tendyne valve, the most employed TMVR device for native anatomy that is a Conformitè Européenne (CE) mark [27,28] approved transcatheter mitral valve device designed to be implanted using a transapical approach.…”

“…We will focus our review on the Tendyne valve, the most employed TMVR device for native anatomy that is a Conformitè Européenne (CE) mark [27,28] approved transcatheter mitral valve device designed to be implanted using a transapical approach. It is repositionable and retrievable and available in a large number of sizes [6][7][8][9][10][11][12][13][14][15][27][28][29]. Initially feasible for MR in ongoing investigations is showing promising results also in the setting of mitral annular calcification and mixed disease [5][6][7][8][9][10][11][12][13][14][15][27][28][29][30].…”