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Transcatheter Mitral Valve Interventions for Mitral Regurgitation: A Review of Mitral Annuloplasty, Valve Replacement, and Chordal Repair Devices

      Significant mitral regurgitation (MR) is the most common valvular disease in the United States in patients older than 75. However, many patients with severe MR are at a high risk for surgical repair due to other significant comorbidities. Over the past decade, many transcatheter mitral valve devices have been studied that address the different mechanisms of MR, but only a few have received a Conformité Européene (CE) mark or United States Food and Drug Administration (FDA) approval. The Carillon, Cardioband, and Mitralign all received CE marking for percutaneous mitral annuloplasty, while the Tendyne and SAPIEN 3 received a CE mark and FDA approval, respectively, for transcatheter mitral valve replacement. Finally, the NeoChord DS 1000 received a CE mark for transcatheter chordal repair. Each of these devices is reviewed in detail, including device indications, performance in clinical trials, anesthetic management, intraprocedural imaging guidance, and postprocedural complications. Although percutaneous devices will appear and disappear from use, understanding the procedural considerations remains highly relevant, as these key principles will apply to the next generation of transcatheter valve interventions.

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      References

        • Nkomo VT
        • Gardin JM
        • Skelton TN
        • et al.
        Burden of valvular heart diseases: A population-based study.
        Lancet. 2006; 368: 1005-1011
        • Nishimura RA
        • Otto CM
        • Bonow RO
        • et al.
        2017 AHA/ACC Focused Update of the 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines.
        J Am Coll Cardiol. 2017; 70: 252-289
        • Gheorghe L
        • Ielasi A
        • Rensing BJWM
        • et al.
        Complications following percutaneous mitral valve repair.
        Front Cardiovasc Med. 2019; 6: 146
        • Krishnaswamy A
        • Kapadia SR.
        Indirect mitral annuloplasty using the carillon device.
        Front Cardiovasc Med. 2020; 7576058
        • Anker SD
        • Starling RC
        • Khan MS
        • et al.
        Percutaneous mitral valve annuloplasty in patients with secondary mitral regurgitation and severe left ventricular enlargement.
        JACC Heart Fail. 2021; 9: 453-462
        • Witte KK
        • Lipiecki J
        • Siminiak T
        • et al.
        The REDUCE FMR Trial.
        JACC Heart Fail. 2019; 7: 945-955
        • Gheorghe LL
        • Mobasseri S
        • Agricola E
        • et al.
        Imaging for native mitral valve surgical and transcatheter interventions.
        JACC Cardiovasc Imaging. 2021; 14: 112-127
        • Siminiak T
        • Wu JC
        • Haude M
        • et al.
        Treatment of functional mitral regurgitation by percutaneous annuloplasty: Results of the TITAN Trial.
        Eur J Heart Fail. 2012; 14: 931-938
        • Schofer J
        • Siminiak T
        • Haude M
        • et al.
        Percutaneous mitral annuloplasty for functional mitral regurgitation: Results of the CARILLON Mitral Annuloplasty Device European Union study.
        Circulation. 2009; 120: 326-333
        • Nickenig G
        • Hammerstingl C
        • Schueler R
        • et al.
        Transcatheter Mitral Annuloplasty in Chronic Functional Mitral Regurgitation.
        JACC Cardiovasc Interv. 2016; 9: 2039-2047
        • Maisano F
        • Taramasso M
        • Nickenig G
        • et al.
        Cardioband, a transcatheter surgical-like direct mitral valve annuloplasty system: Early results of the feasibility trial.
        Eur Heart J. 2016; 37: 817-825
        • Shapira Y.
        The Cardioband annuloplasty system: Is it ready for prime time?.
        Eur Heart J. 2019; 40: 473-475
        • Messika-Zeitoun D
        • Nickenig G
        • Latib A
        • et al.
        Transcatheter mitral valve repair for functional mitral regurgitation using the Cardioband system: 1 year outcomes.
        Eur Heart J. 2019; 40: 466-472
        • Geyer M
        • Sotiriou E
        • Tamm AR
        • et al.
        Advanced protocol for three-dimensional transesophageal echocardiography guidance implementing real-time multiplanar reconstruction for transcatheter mitral valve repair by direct annuloplasty.
        J Am Soc Echocardiogr. 2019; 32: 1359-1365
        • Khalique OK
        • Hahn RT.
        Percutaneous mitral valve repair: Multi-modality cardiac imaging for patient selection and intra-procedural guidance.
        Front Cardiovasc Med. 2019; 6 (20): 142
        • Pieri M
        • Belletti A
        • Oriani A
        • et al.
        Anesthetic management of Cardioband implantation: Data from a preliminary experience and new insights.
        J Cardiothorac Vasc Anesth. 2017; 31: 482-488
        • Sorini Dini C
        • Landi D
        • Meucci F
        • et al.
        Unexpected delayed complete atrioventricular block after Cardioband implantation.
        Catheter Cardiovasc Interv. 2018; 92: 1201-1204
        • Mandinov L
        • Asch FM
        • Grube E.
        Mitralign percutaneous annuloplasty system for the treatment of functional mitral regurgitation.
        Eur Cardiol. 2010; 6: 67-70
        • Schueler R
        • Nickenig G.
        The Mitralign: Strategies for optimal patient selection and optimised results.
        EuroIntervention. 2016; 18: Y67-Y69
        • Nickenig G
        • Schueler R
        • Dager A
        • et al.
        Treatment of chronic functional mitral valve regurgitation with a percutaneous annuloplasty system.
        J Am Coll Cardiol. 2016; 67: 2927-2936
        • Nickenig G
        • Hammerstingl C.
        The Mitralign transcatheter direct mitral valve annuloplasty system.
        EuroIntervention. 2015; 11: W62-W63
      1. Tendyne. Transcatheter Mitral Valve Implantation Valve (TMVI). Available at: https://www.cardiovascular.abbott/int/en/hcp/products/structural-heart/tendyne-mitral-valve.html. Accessed January 15, 2022.

        • Muller DWM
        • Farivar RS
        • Jansz P
        • et al.
        Transcatheter mitral valve replacement for patients with symptomatic mitral regurgitation: A global feasibility trial.
        J Am Coll Cardiol. 2017; 69: 381-391
        • Sorajja P
        • Moat N
        • Badhwar V
        • et al.
        Initial feasibility study of a new transcatheter mitral prosthesis.
        J Am Coll Cardiol. 2019; 73: 1250-1260
        • Muller DWM
        • Sorajja P
        • Duncan A
        • et al.
        2-year outcomes of transcatheter mitral valve replacement in patients with severe symptomatic mitral regurgitation.
        J Am Coll Cardiol. 2021; 78: 1847-1859
        • Beller JP
        • Rogers JH
        • Thourani VH
        • et al.
        Early clinical results with the Tendyne transcatheter mitral valve replacement system.
        Ann Cardiothorac Surg. 2018; 7: 776-779
        • Gregory SH
        • Sodhi N
        • Zoller JK
        • et al.
        Anesthetic considerations for the transcatheter management of mitral valve disease.
        J Cardiothorac Vasc Anesth. 2019; 33: 796-807
        • Grinberg D
        • Pozzi M
        • Bernard C
        • et al.
        A tensed Tendyne.
        Eur J Cardiothorac Surg. 2020; 58: 651-653
        • Yoon S-H
        • Whisenant BK
        • Bleiziffer S
        • et al.
        Outcomes of transcatheter mitral valve replacement for degenerated bioprostheses, failed annuloplasty rings, and mitral annular calcification.
        Eur Heart J. 2019; 40: 441-451
        • Eleid MF
        • Cabalka AK
        • Williams MR
        • et al.
        Percutaneous transvenous transseptal transcatheter valve implantation in failed bioprosthetic mitral valves, ring annuloplasty, and severe mitral annular calcification.
        JACC Cardiovasc Interv. 2016; 9: 1161-1174
        • Yoon S-H
        • Whisenant BK
        • Bleiziffer S
        • et al.
        Transcatheter mitral valve replacement for degenerated bioprosthetic valves and failed annuloplasty rings.
        J Am Coll Cardiol. 2017; 70: 1121-1131
        • Seeburger J
        • Rinaldi M
        • Nielsen SL
        • et al.
        Off-pump transapical implantation of artificial neo-chordae to correct mitral regurgitation.
        J Am Coll Cardiol. 2014; 63: 914-919
        • Kiefer P
        • Meier S
        • Noack T
        • et al.
        Good 5-year durability of transapical beating heart off-pump mitral valve repair with neochordae.
        Ann Thorac Surg. 2018; 106: 440-445
        • Gerosa G
        • Nadali M
        • Longinotti L
        • et al.
        Transapical off-pump echo-guided mitral valve repair with neochordae implantation mid-term outcomes.
        Ann Cardiothorac Surg. 2021; 10: 131-140
        • Wunderlich NC
        • Beigel R
        • Ho SY
        • et al.
        Imaging for mitral interventions.
        JACC Cardiovasc Imaging. 2018; 11: 872-901
        • Demetrio P
        • Andrea C
        • Gianclaudio F
        • et al.
        Transesophageal echocardiography in NeoChord procedure.
        Ann Card Anaesth. 2015; 18: 191
        • Kavakli AS
        • Ozturk NK
        • Ayoglu RU
        • et al.
        Anesthetic management of transapical off-pump mitral valve repair with NeoChord implantation.
        J Cardiothorac Vasc Anesth. 2016; 30: 1587-1593
        • Colli A
        • Adams D
        • Fiocco A
        • et al.
        Transapical NeoChord mitral valve repair.
        Ann Cardiothorac Surg. 2018; 7: 812-820
        • Ahmed A
        • Abdel-Aziz TA
        • AlAsaad MMR
        • et al.
        Transapical off-pump mitral valve repair with NeoChord implantation: A systematic review.
        J Card Surg. 2021; 36: 1492-1498