Patient selection for trans-catheter mitral valve repair vs. replacement: Ongoing indications and glimpse to the future

Abstract

Transcatheter therapies for patients with severe mitral regurgitation are increasingly performed in recent years. While transcatheter mitral valve repair (TMVR) is now a consolidated intervention with > 100,000 procedures performed worldwide, TMV replacement (TMVRpl) is in its early stages and can only be offered by a few centers. The complexity of mitral valve anatomy requires careful evaluation when selecting the best approach and the most suitable device. At present, the clinical experience with TMVRpl is still in a preliminary phase. Most of the patients treated with this approach thus far are high-risk candidates who have undergone a very restrictive clinical and anatomical selection. Therefore, it is difficult to correctly define which patients might benefit more from TMVRpl than from TMVR. We review the clinical, pathophysiological, and technical factors to suggest when to prefer TMVR instead of a replacement technique.