Mitral Regurgitation in the High-Risk Patient: Integrating an Expanding Armamentarium of Transcatheter Devices Into the Treatment Algorithm

Craig Basman; Joel A. Johnson; Luigi Pirelli; Nirav Patel; Carl D. Reimers; Varinder Singh; S. Jacob Scheinerman; Chad Kliger

doi:10.1097/crd.0000000000000412

August 9, 2021Cardiology in Review

Mitral Regurgitation in the High-Risk Patient: Integrating an Expanding Armamentarium of Transcatheter Devices Into the Treatment Algorithm

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Why the study?

While guidelines support MitraClip for high or prohibitive surgical risk patients, many remain anatomically unsuited, amidst an expanding armamentarium of transcatheter repair and replacement strategies.

Key Points

To review clinical strategies, device selection, and failure management for transcatheter mitral valve repair and replacement in patients with degenerative and functional mitral regurgitation at high or prohibitive surgical risk.
Narrative review synthesizing current practice guidelines and transcatheter approaches for high-risk mitral valve disease.
Evaluates procedural suitability for approved edge-to-edge repair alongside novel investigational replacement and repair systems.
MitraClip remains the only FDA-approved transcatheter mitral valve device for patients with high or prohibitive surgical risk.
A substantial subset of high-risk patients are anatomically ineligible for MitraClip, necessitating investigational transcatheter repair and replacement alternatives.
Management pathways must address procedural limitations, anatomical complexity, and strategy failures in both functional and degenerative etiologies.

Structured PICO

P

Population

High or prohibitive surgical risk patients with degenerative and functional mitral regurgitation

I

Intervention

Transcatheter mitral valve repair and replacement strategies (including MitraClip and investigational devices)

This review outlines the approach to selecting transcatheter treatment options for high-risk patients with mitral regurgitation, including management of therapy failure.

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Implication

May guide transcatheter option selection for high-risk mitral regurgitation; leaves open optimal management of therapy failure.

Abstract

Over the last decade, multiple transcatheter mitral valve repair and replacement strategies have emerged, yet there is only 1 US Food and Drug Administration approved device, the MitraClip (Abbott Vascular, Inc., Santa Clara, CA). Current guidelines support the use of the MitraClip in high or prohibitive surgical risk patients, but there are many patients that are not anatomically suited for the device. This review article discusses the approach to degenerative and functional mitral regurgitation in the high-prohibitive risk patient, how to choose transcatheter treatment options (both approved and investigational), and potential management for therapy failure.

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Cite This Study

Basman et al. (2021) studied this question.

synapsesocial.com/papers/69f7e284b3779c4692288f3d https://doi.org/10.1097/crd.0000000000000412

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Mitral Regurgitation in the High-Risk Patient: Integrating an Expanding Armamentarium of Transcatheter Devices Into the Treatment Algorithm

Key Points

Structured PICO

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Mitral Regurgitation in the High-Risk Patient: Integrating an Expanding Armamentarium of Transcatheter Devices Into the Treatment Algorithm

Key Points

Structured PICO

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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