M.H Mandegar - MD, Cardiovascular surgeon

Transcatheter mitral valve replacement has recently emerged as an exciting new frontier in the field of cardiac structural interventions. Although transcatheter aortic valve replacement is a well-established treatment option for patients with symptomatic severe calcific aortic stenosis, the experience with transcatheter mitral valve remains at an early stage. There have been important challenges in the development of this technology, including the complexity of the mitral valve anatomy involving a saddle oval shape, the subvalvular apparatus, the interaction with the left ventricular outflow tract (LVOT) and the aortic valve, as well as the large size of transcatheter MVR devices and large catheters for implantation. At this stage of development, all of these limit the delivery approach to transapical in most cases. The wide variety of mitral pathology, from stenosis to multiple mechanisms of regurgitation, also adds to the difficulties of valve design. Furthermore, the patients being considered for transcatheter MVR are usually high risk with multiple comorbidities, including frailty, pulmonary hypertension, or severe left ventricular systolic dysfunction, each of which negatively impact the overall clinical outcome. Despite these technical, anatomic, and clinical limitations, there has been significant progress in the last couple of years.The type of transcatheter heart valve that best suits a specific patient varies according to the underlying pathology to be treated. Transcatheter MVR in Failed Surgical Bioprostheses or RingsTranscatheter MVR in Native Mitral Valves