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Review
. 2021 Jan;10(1):75-84.
doi: 10.21037/acs-2020-mv-217.

Surgical versus transcatheter mitral valve replacement in functional mitral valve regurgitation

Erik J Scott  1 , Evan P Rotar  1 , Eric J Charles  1 , D Scott Lim  2 , Gorav Ailawadi  3
Affiliations
Review

Surgical versus transcatheter mitral valve replacement in functional mitral valve regurgitation

Erik J Scott et al. Ann Cardiothorac Surg. 2021 Jan.

Abstract

Surgical mitral valve intervention for severe functional, or secondary mitral regurgitation is a viable option for patients deemed to be operative candidates and can be performed via traditional sternotomy or by minimally invasive techniques with similar outcomes. Transcatheter mitral valve replacement is an emerging technology with a potential role in the treatment of functional mitral valve regurgitation. A plethora of devices are currently in development and in various stages of clinical investigation. Operative approach to transcatheter mitral valve replacement varies from a percutaneous transseptal approach to a hybrid percutaneous/surgical apical approach. The Tendyne, Intrepid and Evoque systems show promising results from their early feasibility studies in treatment of patients with mitral regurgitation that were too high risk for surgery. In this review, we describe considerations for surgical and transcatheter mitral valve replacement for functional mitral valve regurgitation.

Keywords: Functional mitral valve insufficiency; surgical mitral valve replacement (SMVR); transcatheter mitral valve replacement (TMVR).

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Conflict of interest statement

Conflicts of Interest: DSL, MD: Research grants: Edwards, Abbott; Gorav Ailawadi, MD, MBA: Consulting: Medtronic, Admedus, Gore, Edwards, Abbott, Atricure (all <5K). The other authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Transcatheter heart valves used for the treatment of mitral valve disease. (A) Tendyne Mitral Valve System (courtesy of Tendyne Holdings, LLC., Roseville, MN, USA); (B) Intrepid TMVR System (courtesy of Medtronic, Irvine, CA, USA); (C) Evoque TMVR System (courtesy of Edwards Lifesciences Corp., Irvine, CA, USA). TMVR, transcatheter mitral valve replacement.
Figure 2
Figure 2
SUMMIT trial inclusion and exclusion criteria. NYHA, New York Heart Association.
Figure 3
Figure 3
Apollo trial inclusion and exclusion criteria.
Figure 4
Figure 4
Trial design for the SUMMIT trial, which evaluated the Tendyne transapical mitral valve system for the treatment of symptomatic mitral regurgitation. *, 2017 ASE Guidelines; †, associated with MR ≥ Grade III, severe MS, or moderate MR with moderate MS. MR, mitral regurgitation; MS, mitral stenosis; MAC, mitral annular calcification; TMVI, transcatheter mitral valve implantation.
Figure 5
Figure 5
Trial design for the Apollo trial, which evaluated the Apollo transcatheter mitral valve system for the treatment of symptomatic mitral regurgitation. Figure provided by Medtronic. MAC, mitral annular calcification; TMVR, transcatheter mitral valve replacement.
Figure 6
Figure 6
Evoque trial inclusion and exclusion criteria.
Video
Video
Surgical versus transcatheter mitral valve replacement in functional mitral valve regurgitation.
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