Surgical or transcatheter mitral valve intervention: complex disease requires complex decisions

Abstract

.The complexity of the aortic valve anatomy and the aetiology of degenerative AS are limited; surgical AVR is a relatively straightforward procedure in which the native valve is replaced by a prosthetic valve. Moreover, much of the enthusiasm associated with TAVI is generated by the self-evident principle of the procedure. This is underlined by the fact that current transcatheter aortic valves on the market are designed using the same principle: a transcatheter valve is placed inside the native valve. Global enthusiasm and the advent of new devices set the stage for exploring TAVI in lower-risk patients and ongoing trials are including patients at intermediate risk. Indeed, risk assessment is complicated but the most important factors affecting prognosis are age and comorbidities 3,4 . Transcatheter valve interventions for mitral valve disease have been available for several decades but have not been adopted as much as TAVI procedures, even though many patients with severe mitral regurgitation (MR) eligible for treatment are denied surgery