Mitral Valve Replacement Surgery Research Articles

Rehabilitation Program in a Patient Undergoing Mitral and Aortic Valve Replacement Surgery

Heart disease due to valvular anomaly has increased prevalence along with increasing age. The operative management including reparation or substitution with prosthetic valve is the main therapy. Still becoming question mark either rehabilitation program is benefcience for patient undergoing valvular surgery. We report a patient with heart failure due to valvular heart disease and underwent double valve replacement surgery. Cardiac rehabilitation phase 1 and phase 2 was done. Patient feel physical condition is much better than before.

Comparative study between CardiaMed valves (freely floating valve leaflets) versus St. Jude Medical (fixed valve leaflets) in mitral valve replacement surgery

BackgroundWith the availability of a wide variety of valve prostheses, surgeons are still searching for the ideal valve, striving for improved hemodynamics, durability and thrombogenicity.The purpose of this prospective, randomized, comparative study was to evaluate the early post-operative hemodynamic function and major clinical events in patients receiving CardiaMed™ prosthetic valves in comparison to St. Jude Medical™ (SJM) valves in the mitral valve position. MethodsBetween Sept 2013 and Sept 2015, 60 elective mitral valve replacement (MVR) patients in Ain Shams Hospital, Cairo, Egypt were divided into two groups of 30. Group I received the CardiaMed valve and Group II received the SJM valve. All patients were followed up at discharge from hospital, and at three and six months post-operatively. ResultsThere were no statistical differences between groups regarding the demographic data, preoperative clinical and functional NYHA class, cardiac assessment or mitral valve pathology. By the end of the follow up, there was no valve-related co-morbidity. Early post-operative complications were seen in 4 patients (13.3%) in Group I and in 5 patients in Group II (16.7%), namely; re-exploration for bleeding, rhythm disturbance, or wound infection. The PPG and MPG were slightly higher in Group I (10.9 ± 1.2 and 5.3 ± 0.9) than in Group II (10.2 ± 2.3 and 5.2 ± 1.3); p = 0.798 and 0.107 respectively. There was no significant statistical difference between the groups regarding the post-operative echo follow-up data. ConclusionsCardiaMed freely floating leaflet prostheses showed good hemodynamic characteristics. The prosthesis adequately corrects hemodynamics and is safe and no worse than the St. Jude Medical valve in the mitral valve position.

Short- and long-term results after prosthetic mitral valve implantation in patients with severe mitral annulus calcification†.

To investigate short- and long-term outcomes of a conservative decalcification approach in mitral valve replacement (MVR) surgery in the presence of mitral annulus calcification (MAC). Of the 1038 patients who underwent MVR, 133 (13%) had significant MAC with at least 30% of the annular circumference heavily calcified. In most patients, the surgical approach to MAC included conservative decalcification, supra-annular prosthesis implantation and insertion of a pericardial patch between the MV annulus and the prosthesis. These patients were matched by a propensity score to a group of patients who underwent MVR without MAC ( n = 118 in each group) and served as a control group. There were 6 early deaths in each group with an overall mortality of 5% ( P = 0.90). Early complications included one major stroke in the non-MAC group and acute renal failure needing dialysis in 2 and 3 patients in the MAC and non-MAC groups, respectively. Mean follow-up was 55 ± 37 months and 99.1% complete. There were 38 (33%) and 33 (29%) late deaths with an estimated survival of 61% and 69% at 6 years in the MAC and non-MAC groups, respectively ( P = 0.55). At follow-up, functional class did not differ between groups ( P = 0.096). Mean echo follow-up time was 40 ± 35 months and was 83% complete. Freedom from moderate or severe mitral regurgitation was 95% and 98%, with an estimated freedom of 95% and 96% at 6 years ( P = 0.20), and mean gradient was 4.9 ± 2.3 mmHg and 5.2 ± 2.0 mmHg for MAC and non-MAC groups, respectively ( P = 0.58). A conservative approach for dealing with MAC is suitable for the majority of patients. Early and late clinical and echocardiographic outcomes did not differ between the MAC and non-MAC patients, including freedom from early and late occurrence of MV prosthesis paravalvular leak.

A case of right middle cerebral artery ‘tendonectomy’ following mitral valve replacement surgery

Following mechanical mitral valve replacement surgery, a 69-year-old woman had an ischemic stroke in the right middle cerebral artery territory. Mechanical thrombectomy showed the embolus to be a piece of...

The Efficacy of Tranexamic Acid Versus Epsilon Amino Caproic Acid in Decreasing Blood Loss in Patients Undergoing Mitral Valve Replacement Surgery

Open heart surgeries under cardiopulmonary bypass are associated with excessive perioperative bleeding that often requires re-exploration. Antifibrinolytics like epsilon aminocaproic acid and tranexamic acid are widely used to control bleeding. There is paucity of literature on studies to reduce blood loss and blood transfusion following mitral valve replacement surgeries. The aim of this study was to compare incidence of re-exploration, blood loss and blood transfusion following mitral valve replacement surgeries in patients who were administered either tranexamic acid or epsilon amino caproic acid. However their efficacy has not been studied in mitral valve replacement surgeries. This is a prospective, randomized, double blind study performed among sixty patients of either sex in the age group of 18 to 60 years scheduled for mitral valve replacement surgeries. They were randomly allocated into two groups, Group 1 (TA n=3O) tranexeamic acid 20 mg/kg body weight diluted in 20ml syringe over 20 min as bolus at time of induction of anaesthesia, infusion of 2mg/kg/hr started continued throughout surgery and continued till 6 hour post operatively in recovery room. Group 2 (EACA n=30) epsilon amino caproic acid 100 mg/kg body wt bolus diluted to 20 ml syringe over 20 min as bolus at time of induction of anaesthesia, infusion 20mg/kg/hr started continued throughout surgery and continued till 6 hour post operatively in recovery room. After admission to intensive care unit total blood loss, transfusion requirements during the first 24 hours and other complications were recorded. In our study we found that mean post operative blood loss in tranexamic acid group 416+47.74 (ml) which is lower than epsilon amino caproic acid group 489+42.12 (ml) that is statistically significant. 16 out of 30 patients in TA group i.e. 53.3% patients received transfusion, where as in EACA group 21 out of 30 patients i.e. 70% patients received transfusion. The total transfusion requirements, total donor unit exposure and financial cost of blood components are less in the tranexamic acid group. Prophylactic tranexamic acid effectively reduces perioperative blood loss in mitral valve replacement surgery.

Functional Characterization of Preadipocytes Derived from Human Periaortic Adipose Tissue.

Adipose tissue can affect the metabolic control of the cardiovascular system, and its anatomic location can affect the vascular function differently. In this study, biochemical and phenotypical characteristics of adipose tissue from periaortic fat were evaluated. Periaortic and subcutaneous adipose tissues were obtained from areas surrounding the ascending aorta and sternotomy incision, respectively. Adipose tissues were collected from patients undergoing myocardial revascularization or mitral valve replacement surgery. Morphological studies with hematoxylin/eosin and immunohistochemical assay were performed in situ to quantify adipokine expression. To analyze adipogenic capacity, adipokine expression, and the levels of thermogenic proteins, adipocyte precursor cells were isolated from periaortic and subcutaneous adipose tissues and induced to differentiation. The precursors of adipocytes from the periaortic tissue accumulated less triglycerides than those from the subcutaneous tissue after differentiation and were smaller than those from subcutaneous adipose tissue. The levels of proteins involved in thermogenesis and energy expenditure increased significantly in periaortic adipose tissue. Additionally, the expression levels of adipokines that affect carbohydrate metabolism, such as FGF21, increased significantly in mature adipocytes induced from periaortic adipose tissue. These results demonstrate that precursors of periaortic adipose tissue in humans may affect cardiovascular events and might serve as a target for preventing vascular diseases.

A Case of Pulmonary Hypertensive Crisis after Mitral Valve Replacement Surgery

A Case of Pulmonary Hypertensive Crisis after Mitral Valve Replacement Surgery

New Intracardiac Mass in Right Atrium Postcardiac Surgery: Thrombus or Artifact?

ABSTRACT Intracardiac masses namely thrombus, vegetation, and tumors may have overlapping echocardiographic appearance. Differentiating them from artifacts and normal anatomic structures further adds to the confusion. We report a similar scenario about the appearance of a new hyperechoic mass in the right atrium (RA) after mitral valve replacement (MVR) surgery. How to cite this article Choudhary M, Aggarwal S, Bhoje A. New Intracardiac Mass in Right Atrium Postcardiac Surgery: Thrombus or Artifact? J Perioper Echocardiogr 2017;5(1):25-26.

Single-Dose Lignocaine-Based Blood Cardioplegia in Single Valve Replacement Patients.

Objective Myocardial protection is the most important in cardiac surgery. We compared our modified single-dose long-acting lignocaine-based blood cardioplegia with short-acting St Thomas 1 blood cardioplegia in patients undergoing single valve replacement.MethodsA total of 110 patients who underwent single (aortic or mitral) valve replacement surgery were enrolled. Patients were divided in two groups based on the cardioplegia solution used. In group 1 (56 patients), long-acting lignocaine based-blood cardioplegia solution was administered as a single dose while in group 2 (54 patients), standard St Thomas IB (short-acting blood-based cardioplegia solution) was administered and repeated every 20 minutes. All the patients were compared for preoperative baseline parameters, intraoperative and all the postoperative parameters.ResultsWe did not find any statistically significant difference in preoperative baseline parameters. Cardiopulmonary bypass time were 73.8±16.5 and 76.4±16.9 minutes (P=0.43) and cross clamp time were 58.9±10.3 and 66.3±11.2 minutes (P=0.23) in group 1 and group 2, respectively. Mean of maximum inotrope score was 6.3±2.52 and 6.1±2.13 (P=0.65) in group 1 and group 2, respectively. We also did not find any statistically significant difference in creatine-phosphokinase-MB (CPK-MB), Troponin-I levels, lactate level and cardiac functions postoperatively.Conclusion This study proves the safety and efficacy of long-acting lignocaine-based single-dose blood cardioplegia compared to the standard short-acting multi-dose blood cardioplegia in patients requiring the single valve replacement. Further studies need to be undertaken to establish this non-inferiority in situations of complex cardiac procedures especially in compromised patients.

A Therapeutic Challenge: Management of Atrial Thrombus

Introduction: Primary cause of atrial thrombi include atrial fibrillation, foreign bodies inside the atrium such as catheters and pacemaker leads, emboli of deep venous thrombus and primary or metastatic tumors of the heart. We review the clinical features, epidemiology, diagnosis and treatment of nine intriguing cases with atrial thrombus. Methods: This is a retrospective study of nine patients (seven female (78%), two male (33%)) who were diagnosed with atrial thrombi (average age of 50 ± 12 years) and were treated at the Ondokuz Mayis University, Department of Cardiovascular Surgery from February 2014 to January 2015. Among them, six patients had atrial fibrillation (one male, five female), seven patients were suffering from dispne and orthopnoea, five patients were suffering from leg swelling, seven patients had a history of hypertension and three patients had a history of mitral valve replacement surgery. Results: All patients underwent surgery except one. Four patients recovered uneventfully and discharged with oral anticoagulation (warfarin) therapy (adjusted to maintain an international normalized ratio of INR between two and three times). Five of nine patients (55%) died after surgery. Conclusion: The response to the thrombolytic therapy is poor, mostly ineffective and unsafe so it is often recommended as a bridge to surgery. In patients diagnosed with mechanical mitral valve thrombosis, medical therapy has the possibility of end organ emboli and also fail to resolve the organised thrombus on the stuck valve. On the other hand surgery does not always give satisfactory results. J Clin Exp Invest 2016; 7(4): 278-282

Early postoperative paravalvular leak among Egyptian population: An observational study

ObjectivesSeveral reports described the incidence of postoperative paravalvular leakage (PVL) early after valve replacement surgery, however, there is a paucity of data regarding the outcomes and complications correlated to the severity of PVL. The aim of the current study was to evaluate the incidence, causes, and short term outcome of early postoperative PVL. MethodsData were collected from patients presenting to the cardiovascular department at Cairo University Hospital for aortic and/or mitral valve replacement surgery from May 2014 to May 2015. Transthoracic echocardiography (TTE) was done for all patients early postoperative. Transesophageal echocardiography (TEE) was done if diagnosis was not confirmed by TTE. All patients with detected PVL were subjected to TTE and TEE after a 3month follow-up period. ResultsTwo hundred patients were enrolled in the study. Seventy five percent of patients were known to have rheumatic heart disease, while 16.5% had infective endocarditis. The mitral valve was replaced in 40% of patients, the aortic valve was replaced in 36%, and other patients had both valves replaced. Early postoperative period PVL was detected in 25 patients. The most common underlying etiologies were rheumatic heart disease and infective endocarditis. PVL was common in patients with both valves replaced compared with either mitral or aortic valve replacement. Infective endocarditis as underlying valve disease was significantly high in patients with PVL compared with those without (p<0.001). ConclusionThe incidence of PVL was high in patients with both valves replaced compared with either mitral or aortic valve replacement. Moreover, every patient with PVL should be properly investigated for infective endocarditis. Surgical intervention, although associated with high morbidity and mortality, reduces PVL recurrence.

Safe Technique of Removal of Left Atrial Thrombus during Mitral Valve Replacement Surgery

Background: Open mitral operation in patients with massive left atrial thrombus still with high mortality due to intra-operative embolism. To prevent this mortality due to intra-operative embolism and to prevent this danger we practiced a surgical technique which includes careful handling of heart and obliteration of left ventricular cavity by bilateral compression.Method: We used this technique in patients of severe mitral stenosis with atrial thrombus during mitral valve replacement. Our technique was to obliterate the left ventricular cavity and thus keep the mitral cusps in a coapted position by placing gauge posterior to left ventricle and a compression over right ventricle by hand of an assistant with a piece of gauze. This obliteration prevented passage of fragments of left atrial thrombus towards collapsed left ventricle.Result: Before practicing this technique, 4 out 9 patients expired due to cerebral embolism . But after implementation of this technique in 17 patients no mortality or morbidity occurred.Conclusion: This technique of removal of left atrial thrombus during mitral valve replacement may be a safe procedure for preventing peroperative embolism.Bangladesh Heart Journal 2016; 31(1) : 26-28

Transcatheter coil embolization of iatrogenic coronary artery–left ventricle fistula after mitral valve replacement

Acquired causes of coronary fistulas are rare disorders and may develop following coronary atherosclerosis, infection, or trauma (iatrogenic). Iatrogenic coronary fistulas may be acquired secondary to surgical or nonsurgical interventions. We describe a case of an iatrogenic coronary artery–left ventricle fistula following mitral valve replacement surgery, presented with ventricular arrhythmia and heart failure. In a unique technique, we implanted three coils with the aid of a Scepter C balloon with inflation at the ostial portion of the left circumflex artery.

Infrequent cardiac manifestations of sarcoidosis

Cardiac sarcoidosis (CS) is found in 2–7% of patients with systemic sarcoidosis (SS). Its diagnosis and treatment is challenging, notwithstanding the poor prognosis and treatment. Hereby, we present a case of systemic sarcoidosis with rare cardiac manifestations of severe mitral incompetence and large coronary aneurysm in a previously healthy woman. She underwent successful mitral valve replacement and coronary artery bypass surgery and was maintained on low dose glucocorticoid therapy.

Differences in atrial fibrillation‑associated proteins between the left and right atrial appendages from patients with rheumatic mitral valve disease: A comparative proteomic analysis.

The majority of proteomic studies have focused on identifying atrial fibrillation (AF)-associated proteins in the right atrium (RA), thus potential differences in AF-associated proteins between the RA and left atrium (LA) remain unknown. The aim of the present study was to perform proteomic analysis to compare the potential differences in AF-associated proteins between the right atrial appendage (RAA) and left atrial appendage (LAA) in patients with rheumatic mitral valve disease (RMVD). RAA and LAA tissues were obtained from 18 patients with RMVD (10 with AF) during mitral valve replacement surgery. Two-dimensional fluorescence difference gel electrophoresis (2-D DIGE) proteomics analysis was performed using these tissues to identify AF-associated proteins in RAA and LAA. Subsequently, the proteomics data was validated using western blot analysis of nine selected proteins. In RAA, 32 AF-associated proteins were significantly dysregulated (15 upregulated and 17 downregulated). In LAA, 31 AF-associated proteins were significantly dysregulated (13 upregulated and 18 downregulated). Among these AF-associated proteins, 17 were AF-associated in both RAA and LAA, 15 were AF-associated only in RAA, and 14 were AF-associated only in LAA. Amongst the differentially expressed proteins, western blot analysis validated the results for 6 AF-associated proteins, and demonstrated similar distributions in RAA and LAA compared with the 2-D DIGE results. Of these proteins, 2 proteins were AF-associated in both RAA and LAA, 2 were AF-associated only in RAA, and 2 were AF-associated only in LAA. Additionally, the different distributions of AF-associated proteins in the RAA and LAA of patients with RMVD was analyzed, which may reflect the different regulatory mechanisms of the RA and LA in AF. These findings may provide new insights into the underlying molecular mechanisms of AF in patients with RMVD.

A Genomics-Based Model for Prediction of Severe Bioprosthetic Mitral Valve Calcification.

Severe bioprosthetic mitral valve calcification is a significant problem in cardiovascular surgery. Unfortunately, clinical markers did not demonstrate efficacy in prediction of severe bioprosthetic mitral valve calcification. Here, we examined whether a genomics-based approach is efficient in predicting the risk of severe bioprosthetic mitral valve calcification. A total of 124 consecutive Russian patients who underwent mitral valve replacement surgery were recruited. We investigated the associations of the inherited variation in innate immunity, lipid metabolism and calcium metabolism genes with severe bioprosthetic mitral valve calcification. Genotyping was conducted utilizing the TaqMan assay. Eight gene polymorphisms were significantly associated with severe bioprosthetic mitral valve calcification and were therefore included into stepwise logistic regression which identified male gender, the T/T genotype of the rs3775073 polymorphism within the TLR6 gene, the C/T genotype of the rs2229238 polymorphism within the IL6R gene, and the A/A genotype of the rs10455872 polymorphism within the LPA gene as independent predictors of severe bioprosthetic mitral valve calcification. The developed genomics-based model had fair predictive value with area under the receiver operating characteristic (ROC) curve of 0.73. In conclusion, our genomics-based approach is efficient for the prediction of severe bioprosthetic mitral valve calcification.

Clinical outcome of totally thoracoscopic cardiac surgery for mitral valve replacement: a series of 634 cases

To summarize the clinical outcome of totally thoracoscopic cardiac surgery for mitral valve replacement. Clinical data of 634 cases undergoing totally thoracoscopic cardiac surgery for mitral valve replacement from May 2004 to February 2016 in Department of Thoracoscopic Cardiacsurgery, Shanghai Yodak Cardiothoracic Hospital was analyzed retrospectively. There were 292 male and 342 female patients, aged from 17 to 68 years with a mean of (45±13) years. All the 634 patients had moderate-severe mitral valve stenosis and (or) incompetence, 263 patients had moderate-severe tricuspid valve incompetence, 356 patients had atrial fibrillation, 46 patients had left atrium thrombosis. Cardiopulmonary bypass was established with right femoral artery and a single 2 stage venus cannula in the right atrium. The ascending aorta was cross-clamped and the myocardium was protected by coronary perfusion with cold crystalloid cardioplegia. Totally thoracoscopic mitral valve replacement were performed. Thirteen cases had incision expanded and 8 cases had conversions to sternotomy. Cardiopulmonary bypass and aortic cross-clamp time were (89±18) minutes and (51±12) minutes, respectively. Operation time was (3.1±1.2) hours. Mechanical ventilation time and intensive care unit stay were (17±6) hours and (27±8) hours, respectively. Postoperation drainage quantity was (390±70) ml. The hospital days was (9.2±2.1) days. There were 5 cases in-hospital deaths. Postoperative complications occurred in 42 cases (6.6%), including 18 cases of right hemoneumothorax, 12 cases of reoperation for bleeding, 3 cases of perivalvular leakage (reoperation was done in 1 patient), 3 cases of low cardiac output syndrome, 2 cases of acute renal failure, 2 cases of inferior vena cava injury, 1 case of right femoral artery thrombosis and liver injury, respectively. The mean duration of follow-up was (58±9) months in 608 cases, with a follow-up rate of 96.7% (608/629). Three patients had died during the period of follow-up caused by congestive heart failure (2 patients) and stroke (1 patient). Late complication among 605 survivors were 37 cases, including 32 cases of moderate tricuspid valve insufficiency, 3 cases of stroke, 1 case of perivalvular leakage and infective endocarditis, respectively.There was no reoperation during the period of follow-up. Totally thoracoscopic cardiac surgery for mitral valve replacement is safe and effective, with unique superiority and clinical feasible.

Multicenter Analysis of Clinical Follow-Ups in Patients with a Star GK Cardiac Valve Replacement for More than One Year

Star GK valves were widely used in China, and we studied the clinical follow-up results of patients with Star GK valve implants for more than one year. Clinical data were collected from those patients who had Star GK valve implants for over one year. Patients were divided into three groups: (1) AVR group: received aortic valve replacement surgery. Based on the valve model this group was further sub-divided into two groups: 21A group, and 23A group; (2) MVR group: received mitral valve replacement surgery. Based on the valve model this group was further sub-divided into three groups: 25M group, 27M group, and 29M group; (3) DVR group: received combined replacement surgeries including AVR + MVR. According to postoperative follow-up time these patients were divided into two groups: 1-year group and 3-year group. Follow-up data were collected by telephone, outpatient visits, or correspondence. Clinical data were aggregated by professional data scientists to conduct independent analyses. 959 patients were included in the study following Star GK valve implant. Follow-up after 1 year found that thrombosis occurred in 4 cases, hemorrhage in 15 cases, left heart failure in 13 cases, paravalvular leakage in 5 cases, and death due to cardiac causes in 2 cases. The long-term efficacy of Star GK valve implants was satisfactory with low incidence of valve-related complications, and following Star GK valve implant, valve and blood were highly compatible and blood component damage was minor. Very low incidence rate of thrombosis was observed following Star GK valve implant, however, attention should be paid to adjust the anticoagulation intensity.

Intraoperative autologous based blood conservation strategies in mitral valve replacement

To evaluate whether intraoperative autologous donation (IAD) can reduce perioperative blood transfusion for patients underwent mitral valve replacement (MVR). A total of 318 patients received implementation of IAD from January 2011 to December 2013 were analyzed retrospectively, and compared with 517 patients of the previous 36-month period (from January 2008 to December 2012). The method of small-volume retrograde autologous priming, strict blood transfusion standard along with IAD together constituted a progressive blood-saving strategy. Statistical methods including Students' t-test, Pearson's χ(2) test, Kruskal-Wallis analysis and multivariate Logistic regression model were used for comparisons of the data. There were no significant difference between IAD group and non-IAD group considering preoperative patient demographics, characteristics and preoperative comorbidities. However, IAD group significantly reduced number of patients transfused with intra/post-operative packed red-blood cell (PRBC) (55(17.0%) vs. 215 (42.1%), χ(2)=53.0, P=0.000), and had significantly reduced postoperative chest tube output (150(380) ml vs. 700(660) ml, H=195.648, P=0.000), length of stay ((16±6) d vs. (20±8)d, t=9.60, P=0.000). But hematocrit were lower in IAD group (30%±5% vs.33%±4% at end of operation, t=7.76, P=0.000; 30%±4% vs. 32%±5% at discharge, P=0.000, t=3.86). Multivariate logistic aggression analysis revealed that age, IAD and smoking history were factors influencing the probability of intra or postoperative blood transfusion. Implementation of blood conservation strategies based on intraoperative autologous donation in mitral valve replacement surgery can significantly reduce intra/postoperative blood transfusion as well as postoperative complications.

Mitral Valve Surgery: Current Minimally Invasive and Transcatheter Options.

The mitral valve is a highly complex structure, the competency and function of which relies on the harmonious action of its component parts. Minimally invasive cardiac surgery (MICS) for mitral valve repair or replacement (MVR/r) has been performed successfully with incremental improvements in techniques over the past decade. These minimally invasive procedures, while attractive to patients and referring physicians, should meet the same high bar for optimal clinical outcomes and long-term durability of valve repair as traditional sternotomy procedures. The majority of MICS MVR/r procedures are performed via a right minithoracotomy approach with direct or camera-assisted visualization, with a minority of centers performing robotic MVR/r. Outcomes with MICS MVR/r have been shown to have similar morbidity and mortality rates as traditional sternotomy MV procedures but with the advantage of reduced transfusions, postoperative atrial fibrillation, and time to recovery. More recently, transcatheter mitral valve repair and replacement (TMVR/r) has become a reality. Percutaneous MV repair technology is currently FDA approved for patients with nonsurgical high-risk degenerative mitral regurgitation. Other TMVR/r technology is at various levels of preclinical and clinical investigation, although these devices are proving to be more challenging compared to transcatheter aortic valve replacement (TAVR) due to the significantly more complex mitral anatomy and the greater heterogeneity of mitral disease requiring treatment. In this article, we review current techniques for MICS MVR/r and upcoming catheter-based therapies for the mitral valve.