Dr. Bernard David Prendergast,
Mitral regurgitation (MR) is a common valve lesion, particularly in the growing elderly population. Professor Iung (Paris, France) emphasised that surgery (preferably valve repair) is the recommended treatment gold standard but is underprovided, especially in high risk elderly patients, when the risk of intervention is felt unacceptable by the surgeon, cardiologist or patient. Percutaneous treatment options are therefore attractive in this cohort.The Mitraclip device (which achieves an edge-to-edge repair akin to the Alfieri surgical procedure) has shown encouraging results in patients with organic MR within the EVEREST II study and in patients with functional MR in the ACCESS registries. A cautious approach to adoption of this technique in carefully selected patients has been advocated by the ESC guidelines on Valvular Heart Disease published in 2012. Professor Maisano (Segrate, Italy) highlighted rapid progress with this technique, which now has an excellent safety and efficacy profile in well selected patients with suitable valvular anatomy.Coronary sinus techniques have now been abandoned in favour of annuloplasty banding techniques, which carry a lower risk of complications. Further technological developments and creative solutions via the transapical approach (developed initially to facilitate transcatheter aortic valve implantation) include transapical mitral valve-in-valve and valve-in-ring procedures (Professor Holzhey, Leipzig, Germany), transcutaneous chordal replacement (Professor Seeburger, Leipzig, Germany) and transcutaneous mitral valve replacement (Professor Sondergaard, Copenhagen, Denmark). Careful development in animal models, innovative skills of interventional cardiologists and cardiac surgeons and further technological developments make this a rapidly evolving field. Watch this space!!
Update on percutaneous mitral valve options
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