Transcatheter Mitral Valve Implantation

T he rationale for the development of a transcatheter mitral valve implantation (tMVI) procedure, either percutaneous or via minimally invasive surgery (MIS), arose from consideration of several key surgical concepts. First, mitral valve replacement is the most effective modality and the gold standard procedure for reliably reducing mitral regurgitation (MR). The efficacy and risks of mitral valve replacement are well understood, but include significant morbidity and mortality due to the incision, as well as the need for cardiopulmonary bypass. The benefits of surgical mitral valve repair relative to replacement in young patients with degenerative disease are much less apparent in older, higher-risk patients. Finally, it is becoming increasingly clear that percutaneous approaches to mitral repair are more limited than surgical techniques and are unlikely to achieve equal efficacy. This article will review and support these concepts, generating a rationale for the development of MIS-tMVI, and describe early investigations in this emerging field.