Peri‐procedural management of transcatheter mitral valve replacement in patients with heart failure

Abstract

Over the past decade, transcatheter mitral valve replacement (TMVR) technologies have evolved with the objective of improving outcomes for patients with severe mitral regurgitation (MR) deemed unsuitable for conventional mitral valve surgery. Although the safety and efficacy of transcatheter edge‐to‐edge mitral valve repair (TEER) is well‐established, there is a sense amongst innovators that a major advantage of TMVR may be to offer a more complete solution for the correction of MR in patients whose complex anatomy means that the likelihood of achieving grade 0 or 1 MR with TEER is low. However, abrupt correction of MR in a poorly prepared left ventricle poses a number of unique haemodynamic challenges, particularly when sudden elimination of regurgitant flow causes a relative increase in left ventricular (LV) afterload. Rapid reduction in LV cavity size following MR elimination may itself result in relative LV outflow tract obstruction (LVOTO), irrespective of the intrinsic risk of LVOTO associated with TMVR. Nevertheless, TMVR on a beating heart affords the opportunity to study real‐time invasive cardiac indices in high‐risk patients with acute reversal of severe MR.

June 2023 at a glance: focus on worsening heart failure, heart failure with preserved ejection fraction and valvular heart disease

“…left ventricular outflow tract obstruction and afterload mismatch) pose new intriguing challenges towards these new devices. Hungerford et al 33 . proposed a review about peri‐procedural management of patients undergoing TMVR.…”

Frailty and transcatheter valve intervention: A narrative review

“…In those well enough to be referred for cardiac surgery, existing preoperative frailty data has demonstrated higher rates of 30‐day and 1‐year mortality, as well as prolonged institutionalization and length of stay 2,3 . Over the past decade, transcatheter aortic valve implantation (TAVI) has become a popular management option for the treatment of severe AS, 4–9 as has transcatheter mitral edge‐to‐edge repair (TEER) become established as a percutaneous treatment option for select patients with severe mitral regurgitation (MR), 10 with valve replacement (TMVR) options continuing to expand 11 . The importance of recognizing frailty in patients referred for transcatheter valve replacement or repair is two‐fold.…”