Mitral valve disease, atrial fibrillation, and device therapy.

Transcatheter mitral interventions have been developed to address an unmet need, and as alternatives to surgery in patients at high risk or considered inoperable. Beyond MitraClip therapy, alternative repair technologies are being developed to expand the armamentarium of transcatheter intervention. Recently, the feasibility of transcatheter mitral valve implantation in native non-calcified valves was reported in patients at very high operative risk. These issues are critically discussed in a timely Clinical Review article entitled ‘The future of transcatheter mitral valve interventions: competitive or complementary role of repair vs replacement?’ by Francesco Maisano from the University Hospital Zurich in Switzerland. The authors review the current state-of-the-art of mitral valve intervention, and identify potential future scenarios that might benefit most from the transcatheter repair and replacement devices under development. He also acknowledges the small body of scientific evidence on hard outcomes during long-term follow-up of these novel procedures. Atrial tachyarrhythmias are often associated with mitral valve disease, but are also frequent in elderly patients without it. As both arrhythmias are associated with a risk of stroke, anticoagulation is considered mandatory in those with a high CHA2DS2VASC score. 6,7