Transcatheter Mitral Valve Replacement in the Transcatheter Aortic Valve Replacement Era.

Abstract

After the success and worldwide adoption of transcatheter aortic valve replacement (TAVR), the percutaneous replacement of a diseased mitral valve (MV) rapidly became a target for investigators and industry. The rejuvenated enthusiasm of industry in this field is also corroborated by the fact that, in 2015, ≈2.5 billion dollars were invested in MV technology development and engineering, making this topic extremely timely. However, although transcatheter aortic Valve replacement has already become the standard of care for the treatment of aortic stenosis (AS) in patients considered at increased risk for conventional surgery,1, 2, 3 transcatheter MV replacement (TMVR) has not yet achieved the same results. MV disease is more common than AS,4, 5 and the surgical approach still remains the gold standard treatment for degenerative mitral regurgitation (MR).3 For patients at high surgical risk who are denied surgery and for whom medical therapy is not sufficient,6 TMVR may mature as a promising therapeutic option.7 As a matter of fact, MR is the most common valve disease, considering that in developed countries the prevalence of rheumatic heart disease and consequent mitral stenosis encountered a dramatic reduction in the past decades.4 Moreover, the increased life expectancy and the growing incidence of ischemic heart disease, combined with advanced medical and interventional therapies, have led ischemic functional secondary MR and degenerative primary MR to further increase.8 Consequently, this growing interest in the development of percutaneous treatment options for MV disease goes parallel with the much higher prevalence of this valvulopathy in the general population, combined with the increased group of high‐risk elderly patients who could not benefit from the standard surgical treatment.9