Mitral regurgitation: a contemporary review of percutaneous mitral valve repair and role of periprocedural imaging

PURPOSE OF REVIEW: This article aims to review recent landmark clinical trials that have resulted in a paradigm shift in the management of patients with mitral regurgitation. This article additionally highlights the instrumental role that structural heart disease (SHD) imaging plays in evaluation of mitral regurgitation and determining candidacy for transcatheter mitral valve repair (TMVr), in addition to the procedural guidance and detection of complications. RECENT FINDINGS: Edge-to-edge TMVr with the MitraClip device (Abbott Vascular, Santa Clara, California) was initially studied and subsequently approved by the US Food and Drug Administration (FDA) for treatment of primary mitral regurgitation in 2013. After the publication of a landmark clinical trial in 2018, the indications have been expanded and FDA has subsequently, in 2019, approved TMVr for patients with functional mitral regurgitation. This has been paralleled by advances in cardiac imaging with more emphasis on the role of SHD imagers as a part of the heart team. SUMMARY: TMVr has revolutionized the management of mitral regurgitation and relies heavily on SHD imaging to ensure optimal outcomes.