Emerging Technologies for Percutaneous Mitral Valve Repair

Mangieri, Antonio; Laricchia, Alessandra; Giannini, Francesco; Gallo, Francesco; Kargoli, Faraj; Ladanyi, Annamaria; Testa, Luca; Colombo, Antonio; Latib, Azeem

doi:10.3389/fcvm.2019.00161

Cited by 20 publications

(16 citation statements)

References 44 publications

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“…In one study examining outcomes of 203 patients with severe MR who have been excluded from the available TMVR protocols, more than 88% of patients were rejected from the early feasibility studies of TMVR due to advanced frailty, with mortality reaching up to 12% in those who were ineligible. That same study found that frailty (15%), severe tricuspid regurgitation (TR) (14%), prior aortic valve therapy (13), mitral anatomical exclusion (16%), severe MAC (7%), and risk of left ventricular outflow tract (LVOT) obstruction (LVOTO; 4%) are the most common causes of TMVR exclusion (6). This review offers a brief insight on the current challenges, potential complications of TMVR, and the measures available to mitigate these complications.…”

Section: Introductionmentioning

confidence: 89%

“…One advantage of surgical MV intervention is that it can be tailored to target the specific pathology of the valvular apparatus. However, today with the detailed pre-procedural planning and with the availability of several transcatheter devices, a targeted pathology approach could be achieved with transcatheter interventions (13). Moreover, the saddle asymmetrical shape of the nonstiff mitral valve annulus and its anatomical relation to the insertion of the papillary muscles make the task to design a transcatheter heart valve (THV) for the treatment of MR Abbreviations: MR, mitral regurgitation; MV, mitral valve; MVr, mitral valve repair; TMVR, transcatheter mitral valve replacement; TAVR, transcatheter aortic valve replacement; TA, transapical; TF, transfemoral; LV, left ventricle; MAC, mitral annulus calcification; ViV, valve-in-valve; ViR, valve-in-ring; ViMAC, valvein-MAC; MDCT, multidetector cardiac tomography; STS, Society of Thoracic Surgeons; THV, transcatheter heart valve; PVL, paravalvular leak; ASA, alcohol septal ablation; LCx, left circumflex coronary artery; AML, anterior mitral leaflet; LVOT, left ventricular outflow tract; LVOTO, left ventricular outflow tract obstruction; iASD, iatrogenic atrial septal defect.…”

Section: Challenges In Designing a Transcatheter Heart Valve For The Mitral Positionmentioning

confidence: 99%

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

Kargoli

Pagnesi

Rahgozar

et al. 2021

Front. Cardiovasc. Med.

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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.

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Section: Introductionmentioning

confidence: 89%

Section: Challenges In Designing a Transcatheter Heart Valve For The Mitral Positionmentioning

confidence: 99%

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

Kargoli

Pagnesi

Rahgozar

et al. 2021

Front. Cardiovasc. Med.

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“…Conversely, mechanical valves are believed to be more resilient as multiple studies report a much lower mortality rate, despite the need for anticoagulation therapy. 31,53,54 The same studies, however, highlighted the worryingly high rates of complications and postoperative mortality. Systematic reviews place the mortality rate anywhere between 10 to 60% after one year, while the risk of developing heart failure can be as high as 31%.…”

Section: Transcatheter Mitral Valve Replacementmentioning

confidence: 96%

“…This is usually the case for older patients with multiple co-morbidities. 7,[27][28][29][30][31] The MitraClip device has 2 essential components: the clip delivery system and a guide catheter. 30 It enters the circulation through the femoral vein and is directed towards the heart.…”

Section: Percutaneous Mitral Valve Repairmentioning

confidence: 99%

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Mitral valve disease: A view on pathophysiology and management of the most common valve disease in the world

Botezatu

Kakar

Ren

et al. 2020

Preprint

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Objectives: Mitral valve disease is increasingly prevalent. Timely diagnosis and the choice of the right intervention are very important in the early stages, as valvular dysfunction often leads to cardiac failure and even sudden death. The focus of this paper is on the various pathologies of the mitral valve, their etiology, and clinical management. Methods: Mitral regurgitation (MR) can be managed surgically, percutaneously or medically. Treatment methods for primary MR include percutaneous mitral valve (MV) repair, MV replacement, minimally invasive mitral valve surgery (MIMVS), and more recently, robotics. Additionally, conventional sternotomy has been used for both MR and mitral stenosis. Nonetheless, ongoing clinical trials are a clear indicator that the management of valve diseases is continuously evolving. Results: Multiple studies favour MV repair via MIMVS, over conventional sternotomy or percutaneous approach. However, more data is needed to optimize patient selection. Robot assisted repair is a new alternative, but attention should be given to the steep learning curve and medical training of professionals wishing to perform this intervention. Cost effectiveness and possible side effects should be explored by clinical trials as well. While guidelines are fairly straightforward for primary MR, there is insufficient evidence to suggest that surgical treatment is advantageous for secondary MR. Management is usually pharmaceutical and aims to treat symptoms rather than cause. Conclusion: Mitral valve disease remains a medical challenge, but numerous research and clinical trials have been embarked upon to refine old methods and discover new ones to improve treatment success and procedural safety.

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