Percutaneous mitral valve repair: an overview of new interventional therapies and associated outcomes

Percutaneous alternatives to conventional surgery for mitral regurgitation have emerged over the last decade with devices modeled after existing surgical techniques. The most developed of these catheter approaches include leaflet repair and annuloplasty. A device that plicates the free edges of the mitral valve to create a double orifice repair is the only leaflet-repair method in development. This technology has completed a randomized trial, but results have yet to be reported. Annuloplasty devices include indirect approaches via the coronary sinus and direct approaches via retrograde left ventricular implantation. There is less human experience with annuloplasty devices than leaflet repair. Leaflet repair has been used in both degenerative and functional mitral regurgitation, while annuloplasty devices are used for annular dilatation associated with functional mitral regurgitation. There is obvious appeal for less invasive approaches in patients who are at high risk of surgery, and ongoing trials will define their ultimate utility in less high-risk patients.