TMVR for the Treatment of Mitral Regurgitation: A State-of-the-Art Review

Figures

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  Figure 1.. Treatment of mitral regurgitation (MR): a simple algorithm. The algorithm shows when to consider transcatheter mitral valve replacement (TMVR). CABG indicates, coronary artery bypass grafting; CT, computed tomography; echo, echocardiography; LVOTO, left ventricular outflow tract obstruction; TEER, transcatheter edge-to-edge repair; and TR, tricuspid regurgitation.

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  Figure 2.. Cardiac computed tomography showing measurement of mitral annulus and neo–left ventricular outflow tract (LVOT). Screening for Tendyne in a patient with previous surgical aortic valve replacement and myectomy. A, D-shaped annulus with relevant measurements in 2-chamber view (upper left), 3-chamber view (lower left), and short axis (right): trigone-to-trigone (TT) distance, intercommissural (IC) distance, and antero-posterior (AP) distance. B, Neo-LVOT area (left) and diameter (right).

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  Figure 3.. Schematic representation of main valve design features to prevent left ventricular outflow tract obstruction (LVOTO). High-profile valves (such as Tendyne [Abbott]) have an increased risk of LVOTO, as blood is forced to pass through the limited space between valve and septum (black arrow; A). The main mechanisms designed to prevent LVOTO include: supra-annular design, as in AltaValve (4C Medical Technologies), which minimizes ventricular protrusion by anchoring to the left atrium (B); a short ventricular profile, as in Intrepid (Medtronic; C); displacement or grasping of anterior mitral leaflet, as in Innovalve (Edwards Lifesciences; D); a modified skirt, as in HighLife Clarity (HighLife SAS; E).

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  Figure 4.. Current transcatheter mitral valve replacement devices and main anchoring mechanisms. (A) Tendyne. (B) Intrepid. (C) EVOQUE Eos. (D) Innovalve. (E) Saturn. (F) Cardiovalve. The circle shows inner composition of the valve to demonstrate leaflet grasping by ventricular legs. (G) Cephea. (H) HighLife. (I) AltaValve. (L) SAPIEN M3. (M) ValvSync. (N) Tioga. (O) Palmetto valve. PET indicates polyethylene terephthalate.

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  Figure 5.. Implantation of currently available devices. For each valve, image A shows intraprocedural angiography, image B shows intraprocedural or postprocedural echocardiography, and image C shows the device released at the end of the procedure. (1) Tendyne; (2) Intrepid; (3) EVOQUE; (4) Innovalve; (5) Saturn (courtesy of InnovHeart); (6) Cardiovalve; (7) Cephea; (8) HighLife (courtesy of HighLife Medical); (9) AltaValve; (10) SAPIEN M3; (11) ValSync (animal model; courtesy of Symbiosis); (12) Tioga (animal model).