Key result
TMVR demonstrates feasibility as an emerging treatment for severe MR.
Why the study?
Transcatheter mitral valve replacement has emerged as a potential therapeutic option for severe mitral regurgitation that may offer advantages over repair, but systems are still under evaluation.
Does transcatheter mitral valve replacement improve outcomes in patients with severe mitral regurgitation at high or prohibitive surgical risk?
Does transcatheter mitral valve replacement improve outcomes in patients with severe mitral regurgitation at high or prohibitive surgical risk?
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“There is no clear indication yet on when to use TMVR for patients with native mitral valve degeneration. Currently, we are using it on patients who are not M-TEER or surgical candidates.”
“For these high-risk individuals, TMVR is an attractive alternative.”
“Many currently available TMVR technologies rely heavily on subvalve fixation, and as a result they use rigid anchoring mechanisms, whether that's achieved by hooks, barbs, paddles or tethers. This interaction can lead to increased risk for LVOT obstructions, limitation in complex mitral valve anatomy, large angular sizes and [mitral annular calcification]. Additionally, it usually interferes with the native mitral valve annular dynamics. As a result, screen failure rates for TMVR technologies go all the way up to 70%.”
TMVR is a feasible emerging therapeutic option for severe mitral regurgitation that may provide more complete MR reduction than edge-to-edge repair, though larger studies are needed.
Transcatheter mitral valve repair, particularly edge-to-edge leaflet repair, is a well-established alternative for patients with severe primary mitral regurgitation (MR) considered at high or prohibitive surgical risk. More recently, transcatheter mitral valve replacement (TMVR) has emerged as a potential therapeutic option for the treatment of severe MR. TMVR may offer some advantages over transcatheter repair by providing a more complete and reproducible MR reduction. Several devices are under preclinical and clinical evaluation, and the early experience with more than 100 patients has demonstrated the feasibility of TMVR. In this review, we describe the TMVR systems currently in development and the results obtained from early clinical experiences. We also discuss the main challenges in and future perspectives on this emerging field. Future studies with a much larger number of patients are needed to provide consistent safety and efficacy data on each of the TMVR systems.
No takes yet. Share an insight, caveat, or question.
Regueiro et al. (2017) conducted a review in Severe mitral regurgitation. Transcatheter mitral valve replacement (TMVR) was evaluated. Transcatheter mitral valve replacement demonstrated feasibility as an emerging therapeutic option for severe mitral regurgitation based on early clinical experience in over 100 patients.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: