Percutaneous mitral valve repair and replacement: a new landmark for structural heart interventions

This editorial refers to ‘Cardioband, a transcatheter surgical-like direct mitral valve annuloplasty system: early results of the feasibility trial’ † , by F. Maisano et al ., on page 817. Mitral regurgitation (MR) is the most common heart valve disease, affecting almost 10% of the population above the age of 75 years. 1 As the population continues to age, the incidence of MR is expected to rise, and the presence of MR has been associated with adverse cardiac events and mortality. 2 Traditionally, MR has been treated by surgery or medical management, depending on the aetiology and stage of the disease. 3 Mitral valve dysfunction is a complex anatomical problem ranging from mitral leaflet disease, annular dilatation from atrial or ventricular dysfunction, leaflet tethering from left ventricular (LV) disease, to a combination of these problems. Since MR commonly accompanies and is aetiologically related to other common ailments of the heart, including coronary artery disease, atrial fibrillation, and LV dysfunction, its contributions to a given patient's symptoms and outcome are difficult to tease out. 4 , 5 To make the situation even more complex, the valve dysfunction may be difficult to quantify in a consistent manner, and the impact of different levels of regurgitation on mortality may vary depending on the cause of MR. 6