Transcatheter Mitral Valve Therapies

Transcatheter mitral valve therapies have become effective, less invasive treatment options for inoperable or high surgical risk patients suffering from severe Mitral Valve Stenosis (narrowing of the mitral valve opening) and symptomatic Mitral Regurgitation (MR), the backward flow of blood into the heart.

MR is the most prevalent valve disease in the western population and is associated with reduced life expectancy and increased risk of heart failure [1,2].

The hemodynamic (blood flow) effects of MR can be severe because of the volume overload it places on the left ventricle (LV).

Surgery is typically recommended for severe MR with symptoms of heart failure, as well as for patients with reduced LV function, pulmonary hypertension or Atrial Fibrillation (AFib) [2].

Transcatheter mitral valve repair (TMVr) and replacement (TMVR) are changing the landscape in MR treatment.

And while a number of innovative new therapies have been introduced to effectively address the different stages of mitral valve disease, outcome data has not yet confirmed the ideal approach for each patient case, with the exception of one – the MitraClip.

The MitraClip device is proving effective in treating certain MR patients, who are not good surgical candidates. Though, surgical repair still yields the best outcomes.

The challenge in establishing effective transcatheter mitral valve therapies that can rival the positive results of Transcatheter Aortic Valve Therapies has to do with the anatomy/shape and location of these two valves. The aortic valve is a circular apparatus sitting at the end of a tube, while the mitral valve is noncircular and sits in the middle of the heart [3].

Additionally, the mitral valve is located near the ventricle outflow tract, an area in which blood flows out of the heart and into the major arteries.

Read Dr. Yazdani’s blog, “A Tale of two Valves: Why is Surgery Still the Preferred Treatment for Mitral Valve Disease?”

References

  1. Enriquez-Sarano M, Avierinos JF, Messika-Zeitoun D, et al. Quantitative determinants of the outcome of asymptomatic mitral regurgitation. N Engl J Med. 2005;352-:875-83.
  2. Vahauian A, Alfieri O, Andreotti F et al. Guidelines o the management of valvular heart disease (version 2012). Eur Heart J. 2012;33:2451-96.
  3. Yazdani S. A tale of two valves: Why is surgery still the preferred treatment for mitral valve disease? (Updated 2018)