The Increasing Use of Mitral Transcatheter Edge-to-Edge Repair in Complex and High-Risk Patients.

Abstract

A timely review by Davies et al. in this edition of Heart, Lung and Circulation expands the scope of utility for transcatheter edge-to-edge repair (TEER) techniques in the management of severe mitral regurgitation (MR) from patients with increased surgical risk to a wider group [ [1] Davies A. Bamford P. Briennese S. Smith R. Transcatheter mitral valve repair—beyond the EVEREST and COAPT criteria. Heart Lung Circ. 2023; 32: 658-665 Google Scholar ]. In particular: to managing complex commissural lesions; in the setting of acute myocardial infarction with chordal rupture; hypertrophic cardiomyopathy with systolic anterior motion of the mitral valve; failed annuloplasty rings; and, patients awaiting heart transplantation or left ventricular assist device with severe MR [ [1] Davies A. Bamford P. Briennese S. Smith R. Transcatheter mitral valve repair—beyond the EVEREST and COAPT criteria. Heart Lung Circ. 2023; 32: 658-665 Google Scholar ]. As indicated in the review, the current commercial availability of two devices—MitraClip (Abbott Laboratories, Chicago, IL, USA) and PASCAL (Edwards Lifesciences, Irvine, CA, USA), in several models, has significantly increased the diversity of patients with elevated surgical risk that may benefit from this option. To date, more than 150,000 MitraClip and nearly 5,000 PASCAL devices have been deployed worldwide [ [2] Abbott Media. Late-breaking data show breadth of Abbott’s minimally invasive structural heart technologies. 2022. http:/abbott.mediaroom.com/2022-09-17-Late-Breaking-Data-Show-Breadth-of-Abbotts-Minimally-Invasive-Structural-Heart-Technologies. [accessed: 29.5.23] Google Scholar ]. The safety and efficacy of TEER for labelled indications has been well established; meanwhile, patients at intermediate surgical risk are currently being enrolled in the REPAIR MR 1 Percutaneous MitraClip Device or Surgical Mitral Valve REpair in PAtients With PrImaRy Mitral Regurgitation Who Are Candidates for Surgery (REPAIR MR) Trial. trial comparing MitraClip with surgical mitral valve repair (SMVR) [ [3] McCarthy P.M. Whisenant B. Asgar A.W. Ailawadi G. Hermiller J. Williams M. et al. Percutaneous MitraClip device or surgical mitral valve repair in patients with primary mitral regurgitation who are candidates for surgery: design and rationale of the REPAIR MR Trial. J Am Heart Assoc. 2023; 12e027504 Google Scholar ]. Transcatheter Mitral Valve Repair—Beyond the EVEREST and COAPT CriteriaHeart, Lung and CirculationVol. 32Issue 6PreviewTranscatheter mitral valve repair (TMVr) has emerged as a safe and effective alternative to conventional surgery in patients with primary and secondary mitral regurgitation, especially those at high surgical risk. This review summarises alternative indications for TMVr outside of the traditional criteria derived from the major randomised trials and focusses on less common mitral valve anatomies such as commissural prolapse and bileaflet prolapse, patients with mitral annuloplasty rings, as well as acutely unwell patients with papillary muscle rupture and/or cardiogenic shock. Full-Text PDF