Selecting patients for percutaneous mitral valve therapy

Patients with severe symptomatic mitral regurgitation benefit from correction of mitral regurgitation. Surgical mitral valve repair or replacement is the current standard of care for these patients. However, high risk of surgery in many of these patients, lack of universal expertise for mitral valve repair and moderate long-term success in correcting functional mitral regurgitation are some of the current challenges. Over the last decade we have witnessed important advances in the development of transcatheter techniques for mitral valve repair to overcome some of these challenges and compliment surgical treatment options. Percutaneous edge-to-edge repair has completed a commendable randomized clinical trial and several other devices have meaningful human experience. The role of these treatment options is evolving at a rapid pace. The use of these options will mostly be driven by the need (high-risk surgical patients and functional mitral regurgitation), anatomical feasibility and, to some extent, by local expertise and opinions. This article focuses on available clinical data and appropriate anatomical features for percutaneous therapies with comparable surgical data, with a view to aid patient selection for this evolving field.