Transcatheter mitral valve interventions: pathophysiological considerations in choosing reconstruction versus transcatheter valve implantation

Over the last few years, several surgical procedures to treat mitral regurgitation (MR) in high-risk or inoperable patients have inspired percutaneous devices, including valve repair and valve replacement technologies. As the field of transcatheter mitral valve intervention is rapidly developing, the interventional community is wondering whether valve implantation should become the leading percutaneous mitral valve therapy, and whether the introduction of reliable replacement technology will reduce the clinical value of repair approaches. Since clinical experience with transcatheter mitral valve implantation (TMVI) is at a preliminary stage and all the patients treated with this approach so far are really sick candidates with prohibitive risk, it is difficult to define properly which patients could benefit more from TMVI versus transcatheter mitral valve repair (TMVR). The specific aim of this report is to state few important clinical and pathophysiological considerations in order to clarify when and why a repair strategy should be preferred over replacement.