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Review
. 2023 Jun;25(6):890-901.
doi: 10.1002/ejhf.2758. Epub 2022 Dec 26.

Peri-procedural management of transcatheter mitral valve replacement in patients with heart failure

Sara L Hungerford  1   2 , Gry Dahle  3   4 , Alison Duncan  5 , Christopher S Hayward  1   6 , David W M Muller  1   6
Affiliations
Free article
Review

Peri-procedural management of transcatheter mitral valve replacement in patients with heart failure

Sara L Hungerford et al. Eur J Heart Fail. 2023 Jun.
Free article

Abstract

Over the past decade, transcatheter mitral valve replacement (TMVR) technologies have evolved with the objective of improving outcomes for patients with severe mitral regurgitation (MR) deemed unsuitable for conventional mitral valve surgery. Although the safety and efficacy of transcatheter edge-to-edge mitral valve repair (TEER) is well-established, there is a sense amongst innovators that a major advantage of TMVR may be to offer a more complete solution for the correction of MR in patients whose complex anatomy means that the likelihood of achieving grade 0 or 1 MR with TEER is low. However, abrupt correction of MR in a poorly prepared left ventricle poses a number of unique haemodynamic challenges, particularly when sudden elimination of regurgitant flow causes a relative increase in left ventricular (LV) afterload. Rapid reduction in LV cavity size following MR elimination may itself result in relative LV outflow tract obstruction (LVOTO), irrespective of the intrinsic risk of LVOTO associated with TMVR. Nevertheless, TMVR on a beating heart affords the opportunity to study real-time invasive cardiac indices in high-risk patients with acute reversal of severe MR.

Keywords: Heart failure; Left ventricular function; Mitral regurgitation; Right ventricular function; Transcatheter edge-to-edge repair; Transcatheter mitral valve replacement.

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