Why the study?
A subgroup of patients with MR are not suitable for either surgical or TEER approaches due to risks of mitral stenosis, inadequate MR reduction, procedural complexity, or futility.
This consensus document highlights the clinical and anatomical limitations of TEER for mitral regurgitation and positions TMVR as a potential alternative for unsuitable patients.
Supports TMVR evaluation in TEER-ineligible mitral regurgitation; extends guideline consensus on structural heart options.
As the experience with transcatheter edge-to-edge device therapy for MR has significantly expanded, it has become increasingly apparent that there is a subgroup of patients who are not suitable for either surgical approaches or TEER approaches. With current-generation device designs for TEER therapy, these limitations are largely due to the creation of mitral stenosis, the inadequate reduction of MR, or patient and clinical factors that either complicate the procedure or are related to futile outcomes. All of these limitations (other than futility) may, in select patients, be better served by the option of TMVR, which is currently the subject of multiple investigations. Additionally, there is the confounding factor of variability in operator and site experience that plays a likely significant role in both determination of patient suitability and subsequent outcomes following TEER device therapy.Figure 8Video 7. Video 8. TEE from a patient with severe MR complicated by a cleft in the posterior leaflet. Images courtesy of Dr. Kostantinos Koulagiannis, Morristown Medical Center..
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Lim et al. (2021) studied this question.
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