Advertisement

Current and Investigational Transcatheter Mitral Valve Replacement Systems: A Narrative Review for the Cardiac Anesthesiologist

      TRANSCATHETER MITRAL VALVE REPLACEMENT (TMVR) systems with bioprosthetic transcatheter heart valves (THV), originally designed for the implantation in the aortic position, have gained widespread acceptance in recent years despite the absence of discrete society recommendations. Numerous dedicated TMVR systems are also currently under investigation. Cardiac anesthesiologists working alongside interventional cardiologists will be expected to provide intraprocedural care, and, potentially, echocardiographic guidance for the current and future TMVR systems. Device-specific echocardiographic training, as well as a knowledge of individual devices and procedural steps, remain essential for optimal care.

      Key Words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Cardiothoracic and Vascular Anesthesia
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Coffey S
        • Cairns BJ
        • Iung B.
        The modern epidemiology of heart valve disease.
        Heart. 2016; 102: 75-85
        • Sundt TM
        • Jneid H.
        Guideline update on indications for transcatheter aortic valve implantation based on the 2020 American College of Cardiology/American Heart Association Guidelines for management of valvular heart disease.
        JAMA Cardiol. 2021; 6: 1088-1089
        • Testa L
        • Popolo Rubbio A
        • Casenghi M
        • et al.
        Transcatheter mitral valve replacement in the transcatheter aortic valve replacement era.
        J Am Heart Assoc. 2019; 8e013352
        • Mack M
        • Carroll JD
        • Thourani V
        • et al.
        Transcatheter mitral valve therapy in the United States: A report from the STS-ACC TVT Registry.
        J Am Coll Cardiol. 2021; 78: 2326-2353
        • Whisenant B
        • Kapadia SR
        • Eleid MF
        • et al.
        One-year outcomes of mitral valve-in-valve using the SAPIEN 3 transcatheter heart valve.
        JAMA Cardiol. 2020; 5: 1245-1252
        • Jain P
        • Fabbro 2nd, M
        ACC expert consensus decision pathway on the management of mitral regurgitation: A review of the 2017 document for the cardiac anesthesiologist.
        J Cardiothorac Vasc Anesth. 2019; 33: 274-289
        • Hahn RT
        • Mahmood F
        • Kodali S
        • et al.
        Core competencies in echocardiography for imaging structural heart disease interventions: An expert consensus statement.
        JACC Cardiovasc Imaging. 2019; 12: 2560-2570
        • Otto CM
        • Nishimura RA
        • Bonow RO
        • et al.
        2020 ACC/AHA guideline for the management of patients with valvular heart disease: Executive summary: A report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines.
        Circulation. 2021; 143: e35-e71
        • Wyler von Ballmoos MC
        • Kalra A
        • et al.
        Complexities of transcatheter mitral valve replacement (TMVR) and why it is not transcatheter aortic valve replacement (TAVR).
        Ann Cardiothorac Surg. 2018; 7: 724-730
        • Alperi A
        • Granada JF
        • Bernier M
        • et al.
        Current status and future prospects of transcatheter mitral valve replacement.
        JACC. 2021; 77: 3058-3078
        • Yoon S-H
        • Bleiziffer S
        • Latib A
        • et al.
        Predictors of left ventricular outflow tract obstruction after transcatheter mitral valve replacement.
        JACC Cardiovasc Interv. 2019; 12: 182-193
        • Cheung AW
        • Gurvitch R
        • Ye J
        • et al.
        Transcatheter transapical mitral valve-in-valve implantations for a failed bioprosthesis: A case series.
        J Thorac Cardiovasc Surg. 2011; 141: 711-715
        • Urena M
        • Vahanian A
        • Brochet E
        • et al.
        Current indications for transcatheter mitral valve replacement using transcatheter aortic valves.
        Circulation. 2021; 143: 178-196
        • Sticchi A
        • Reineke D
        • Praz F
        • et al.
        Transcatheter mitral valve replacement for mitral valve-in-valve, valve-in-ring, and valve-in-MAC using balloon-expandable transcatheter heart valves.
        JACC Cardiovasc Interv. 2021; 14: 873-878
        • Guerrero M
        • Wang DD
        • Pursnani A
        • et al.
        Prospective evaluation of TMVR for failed surgical annuloplasty rings: MITRAL trial valve-in-ring arm 1-year outcomes.
        JACC Cardiovasc Inter. 2021; 14: 846-858
        • Little SH
        • Bapat V
        • Blanke P
        • et al.
        Imaging guidance for transcatheter mitral valve intervention on prosthetic valves, rings, and annular calcification.
        JACC Cardiovasc Imaging. 2021; 14: 22-40
        • Yoon SH
        • 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
        • Guerrero M
        • Eleid M
        • Wang D
        • et al.
        3-year outcomes of transcatheter mitral valve-in-valve, valve-in-ring and valve in-mitral annular calcification: Results from the mitral trial.
        J Am Coll Cardiol. 2022; 79: 576
        • SL Alexis
        • Malik AH
        • El-Eshmawi A
        • et al.
        Surgical and transcatheter mitral valve replacement in mitral annular calcification: A systematic review.
        J Am Heart Assoc. 2021; 10e018514
      1. United States Food and Drug Administration. Summary of safety and effectiveness data. Available at: https://www.accessdata.fda.gov/cdrh_docs/pdf14/P140031S125B.pdf. Accessed July 24, 2022.

        • Vahanian A
        • Beyersdorf F
        • Praz F
        • et al.
        2021 ESC/EACTS guidelines for the management of valvular heart disease: Developed by the Task Force to manage valvular heart disease of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS).
        Eur Heart J. 2022; 43: 561-632
        • Guerrero M
        • Salinger M
        • Pursnani A
        • et al.
        Transseptal transcatheter mitral valve-in-valve: A step by step guide from preprocedural planning to postprocedural care.
        Catheter Cardiovasc Interv. 2018; 92: E185-E196
        • Zoghbi WA
        • Adams D
        • Bonow RO
        • et al.
        Recommendations for noninvasive evaluation of native valvular regurgitation: A report from the American Society of Echocardiography developed in collaboration with the Society for Cardiovascular Magnetic Resonance.
        J Am Soc Echocardiogr. 2017; 30: 303-371
        • Lancellotti P
        • Pibarot P
        • Chambers J
        • et al.
        Recommendations for the imaging assessment of prosthetic heart valves: A report from the European Association of Cardiovascular Imaging endorsed by the Chinese Society of Echocardiography, the Inter-American Society of Echocardiography, and the Brazilian Department of Cardiovascular Imaging.
        Eur Heart J Cardiovasc Imaging. 2016; 17: 589-590
        • Mackensen GB
        • Lee JC
        • Wang DD
        • et al.
        Role of echocardiography in transcatheter mitral valve replacement in native mitral valves and mitral rings.
        J Am Soc Echocardiogr. 2018; 31: 475-490
        • Barreiro-Perez M
        • Caneiro-Queija B
        • Puga L
        • et al.
        Imaging in transcatheter mitral valve replacement: State-of-art review.
        J Clin Med. 2021; 10: 5973
        • Mak GJ
        • Blanke P
        • Ong K
        • Naoum C
        • et al.
        Three-dimensional echocardiography compared with computed tomography to determine mitral annulus size before transcatheter mitral valve implantation.
        Circ Cardiovasc Imaging. 2016; 9e004176
        • Urena M
        • Himbert D
        • Brochet E
        • et al.
        Transseptal transcatheter mitral valve replacement using balloon-expandable transcatheter heart valves: A step-by-step approach.
        JACC Cardiovasc Interv. 2017; 10: 1905-1919
        • Bapat V
        • Pirone F
        • Kapetanakis S
        • et al.
        Factors influencing left ventricular outflow tract obstruction following a mitral valve-in-valve or valve-in-ring procedure, part 1.
        Catheter Cardiovasc Interv. 2015; 86: 747-760
        • Babaliaros VC
        • Lederman RJ
        • Gleason PT
        • et al.
        The art of SAPIEN 3 transcatheter mitral valve replacement in valve-in-ring and valve-in-mitral-annular-calcification procedures.
        JACC Cardiovasc Interv. 2021; 14: 2195-2214
        • Tiwana J
        • Aldea G
        • Levin DB
        • et al.
        Contemporary transcatheter mitral valve replacement for mitral annular calcification or ring.
        JACC Cardiovasc Interv. 2020; 13: 2388-2398
        • Murphy DJ
        • Ge Y
        • Don CW.
        Use of cardiac computerized tomography to predict neo-left ventricular outflow tract obstruction before transcatheter mitral valve replacement.
        J Am Heart Assoc. 2017; 6e007353
        • Guerrero M
        • Wang DD
        • Pursnani A
        • et al.
        A cardiac computed tomography-based score to categorize mitral annular calcification severity and predict valve embolization.
        JACC Cardiovasc Imaging. 2020; 13: 1945-1957
        • Garcia-Sayan E
        • Chen T
        • Khalique OK.
        Multimodality cardiac imaging for procedural planning and guidance of transcatheter mitral valve replacement and mitral paravalvular leak closure.
        Front Cardiovasc Med. 2021; 8582925
        • Blanke P
        • Dvir D
        • Cheung A
        • et al.
        Mitral annular evaluation with CT in the context of transcatheter mitral valve replacement.
        JACC Cardiovasc Imaging. 2015; 8: 612-615
        • Guerrero M
        • Wang DD
        • Eleid MF
        • et al.
        Study of TMVR using balloon-expandable aortic transcatheter valves in MAC: MITRAL trial 1-year outcomes.
        JACC Cardiovasc Interv. 2021; 14: 830-845
        • Khan JM
        • Rogers T
        • Babaliaros VC
        • et al.
        Predicting left ventricular outflow tract obstruction despite anterior mitral leaflet resection: The "skirt NeoLVOT".
        JACC Cardiovasc Imaging. 2018; 11: 1356-1359
        • Guerrero M
        • Eleid M
        • Foley T
        • et al.
        Transseptal transcatheter mitral valve replacement in severe mitral annular calcification (transseptal valve-in-MAC).
        Ann Cardiothorac Surg. 2018; 7: 830-833
        • Ooms J
        • Minet M
        • Daemen J
        • et al.
        Pre-procedural planning of transcatheter mitral valve replacement in mitral stenosis with multi-detector tomography-derived 3D modeling and printing: A case report.
        Eur Heart J Case Rep. 2020; 4: 1-6
        • Blackstone EH
        • Suri RM
        • Rajeswaran J
        • et al.
        Propensity-matched comparisons of clinical outcomes after transapical or transfemoral transcatheter aortic valve replacement: A placement of aortic transcatheter valves (PARTNER)-I trial substudy.
        Circulation. 2015; 131: 1989-2000
        • Kawano Y
        • Newell P
        • Harloff M
        • et al.
        Early outcomes of transatrial mitral valve replacement in severe mitral annular calcification.
        JTCVS Tech. 2021; 9: 49-56
      2. Smith R. Surgical Implantation of TRAnscatheter vaLve in Native Mitral Annular Calcification (SITRAL) study (SITRAL). Available at: https://www.clinicaltrials.Gov/ct2/show/nct02830204?. Accessed April 21, 2022.

        • Harloff MT
        • Chowdhury M
        • Hirji SA
        • et al.
        A step-by-step guide to transseptal valve-in-valve transcatheter mitral valve replacement.
        Ann Cardiothorac Surg. 2021; 10: 113-121
        • 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
        • Notarianni AP
        • Neuburger PJ
        • Patel PA.
        TAVR valves in the mitral position: Forever between a ring and a hard place.
        J Cardiothorac Vasc Anesth. 2021; 35: 1917-1921
        • Pommier T
        • Guenancia C
        • Sagnard A
        • et al.
        Safety and efficacy of transcatheter mitral valve replacement guided by intracardiac echocardiography.
        JACC Cardiovasc Interv. 2021; 14: 1620-1622
        • Cubeddu RJ
        • Sarkar A
        • Navas V
        • et al.
        Minimalist approach’ for transcatheter mitral valve replacement using intracardiac echocardiography and conscious sedation: A case series.
        Eur Heart J Case Rep. 2020; 4: 1-5
        • Poltak JM
        • Cobey FC
        • Augostides JG
        • et al.
        Paravertebral analgesia in transapical transcatheter aortic valve replacement.
        Heart Lung Vessel. 2015; 7: 217-223
        • Berthoud V
        • Ellouze O
        • Bievre T
        • et al.
        Serratus anterior plane block for apical TAVR in an awake patient.
        J Cardiothorac Vasc Anesth. 2018; 32: 2275-2277
        • Shakuo T
        • Kakumoto S
        • Kuribayashi J
        • et al.
        Continuous PECS II block for postoperative analgesia in patients undergoing transapical transcatheter aortic valve implantation.
        JA Clin Rep. 2017; 3: 65
        • Singh GD
        • Smith TW
        • Rogers JH.
        Targeted transseptal access for mitraclip percutaneous mitral valve repair.
        Intervent Cardiol Clin. 2016; 5: 55-69
        • Thaden JJ
        • Sanon S
        • Geske JB
        • et al.
        Echocardiographic and fluoroscopic fusion imaging for procedural guidance: An overview and early clinical experience.
        J Am Soc Echocardiogr. 2016; 29: 503-512
        • Gong FF
        • Peters AC
        • Malaisrie SC
        • et al.
        Optimal imaging guidance during transcatheter mitral valve-in-valve replacement in bioprostheses with radiolucent sewing rings.
        J Am Coll Cardiol Case Rep. 2020; 2: 1129-1134
        • Pirelli L
        • Hong E
        • Steffen R
        • et al.
        Mitral valve-in-valve and valve-in-ring: Tips, tricks, and outcomes.
        Ann Cardiothorac Surg. 2021; 10: 96-112
        • Zoghbi WA
        • Asch FM
        • Bruce C
        • et al.
        Guidelines for the evaluation of valvular regurgitation after percutaneous valve repair or replacement: A report from the American Society of Echocardiography developed in collaboration with the Society for Cardiovascular Angiography and Interventions, Japanese Society of Echocardiography, and Society for Cardiovascular Magnetic Resonance.
        J Am Soc Echocardiogr. 2019; 32: 431-475
        • Zoghbi WA
        • Chambers JB
        • Dumesnil JG
        • et al.
        Recommendations for evaluation of prosthetic valves with echocardiography and doppler ultrasound.
        J Am Soc Echocardiogr. 2009; 22: 975-1014
        • Schueler R
        • Öztürk C
        • Wedekind JA
        • et al.
        Persistence of iatrogenic atrial septal defect after interventional mitral valve repair with the MitraClip system: A note of caution.
        JACC Cardiovasc Interv. 2015; 8: 450-459
        • Isogai T
        • Saad AM
        • Shekhar S
        • et al.
        Risk of percutaneous iatrogenic atrial septal defect closure required shortly after transseptal mitral valve intervention.
        J Am Coll Cardiol Interv. 2020; 13: 2820-2822
        • Zahr F
        • Song HK
        • Chadderdon SM
        • et al.
        30-day outcomes following transfemoral transseptal transcatheter mitral valve replacement: Intrepid TMVR early feasibility study results.
        JACC Cardiovasc Interv. 2022; 15: 80-89
        • Alkhouli M
        • Sarraf M
        • Holmes DR.
        Iatrogenic atrial septal defect.
        Circ Cardiovasc Interv. 2016; 9e003545
        • Losi MA
        • Strisciuglio T
        • Stabile E
        • et al.
        Iatrogenic atrial septal defect (iASD) after MitraClip system delivery: The key role of PaO2/FiO2 ratio in guiding post-procedural iASD closure.
        Int J Cardiol. 2015; 197: 85-86
        • Beri N
        • Singh GD
        • Smith TW
        • et al.
        Iatrogenic atrial septal defect closure after transseptal mitral valve interventions: Indications and outcomes.
        Catheter Cardiovasc Interv. 2019; 94: 829-836
        • Wasmer K
        • Zellerhoff S
        • Köbe J
        • et al.
        Incidence and management of inadvertent puncture and sheath placement in the aorta during attempted transseptal puncture.
        Europace. 2017; 19: 447-457
        • Katritsis GD
        • Zografos T
        • Giazitzoglou E
        • et al.
        Thrombotic cardiac tamponade after transseptal puncture.
        HeartRhythm Case Rep. 2015; 1: 39-40
        • Bapat VVN
        • Khaliel F
        • Ihleberg L.
        Delayed migration of Sapien valve following a transcatheter mitral valve-in-valve implantation.
        Catheter Cardiovasc Interv. 2014; 83: E150-E154
        • Cheung A
        • Webb JG
        • Barbanti M
        • et al.
        5-year experience with transcatheter transapical mitral valve-in-valve implantation for bioprosthetic valve dysfunction.
        J Am Coll Cardiol. 2013; 61: 1759-1766
        • Guerrero M
        • Urena M
        • Himbert D
        • et al.
        1-year outcomes of transcatheter mitral valve replacement in patients with severe mitral annular calcification.
        J Am Coll Cardiol. 2018; 71: 1841-1853
        • Al-Hijji MA
        • El Sabbagh A
        • Guerrero ME
        • et al.
        Paravalvular leak repair after balloon-expandable transcatheter mitral valve implantation in mitral annular calcification: Early experience and lessons learned.
        Catheter Cardiovasc Interv. 2019; 94: 764-772
        • Urena M
        • Vahanian A
        • Brochet E
        • et al.
        Current indications for transcatheter mitral valve replacement using transcatheter aortic valves: Valve-in-valve, valve-in-ring, and valve-in-mitral annulus calcification.
        Circulation. 2021; 143: 178-196
        • Simonato M
        • Whisenant B
        • Ribeiro HB
        • et al.
        Mitral Valve replacement after surgical repair or replacement: Comprehensive midterm evaluation of valve-in-valve and valve-in-ring implantation from the VIVID Registry.
        Circulation. 2021; 143: 104-116
        • Guerrero M
        • Pursnani A
        • Narang A
        • et al.
        Prospective evaluation of transseptal TMVR for failed surgical bioprostheses: MITRAL trial valve-in-valve arm 1-year outcomes.
        JACC Cardiovasc Interv. 2021; 14: 859-872
        • Jain P
        • Patel PA
        • Fabbro 2nd, M
        Hypertrophic cardiomyopathy and left ventricular outflow tract obstruction: Expecting the unexpected.
        J Cardiothorac Vasc Anesth. 2018; 32: 467-477
        • Guerrero M
        • Wang DD
        • Mackram F
        • et al.
        Prospective study of TMVR using balloon-expandable aortic transcatheter valves in MAC: MITRAL trial 1-year outcomes focus on mitral valve interventions.
        JACC Cardiovasc Interv. 2021; 14: 830-845
        • Khan JM
        • Trivedi U
        • Gomes A
        • et al.
        Rescue" LAMPOON to treat transcatheter mitral valve replacement-associated left ventricular outflow tract obstruction.
        JACC Cardiovasc Interv. 2019; 12: 1283-1284
        • Lisko J
        • Kamioka N
        • Gleason P
        • et al.
        Prevention and treatment of left ventricular outflow tract obstruction after transcatheter mitral valve replacement.
        Interv Cardiol Clin. 2019; 8: 279-285
        • Guerrero M
        • Wang DD
        • Himbert D
        • et al.
        Short-term results of alcohol septal ablation as a bail-out strategy to treat severe left ventricular outflow tract obstruction after transcatheter mitral valve replacement in patients with severe mitral annular calcification.
        Catheter Cardiovasc Interv. 2017; 90: 1220-1226
        • Ben-Shoshan J
        • Wang DD
        • Asgar AW.
        Left ventricular outflow tract obstruction: A potential obstacle for transcatheter mitral valve therapy.
        Interv Cardiol Clin. 2019; 8: 269-278
        • Lisko J
        • Kamioka N
        • El Chami M
        • et al.
        TCT-452 Septal Correction to Prevent Iatrogenic Left Ventricular Outflow Tract Obstruction (SCORPION) prior to transcatheter mitral valve replacement.
        J Am Coll Cardiol. 2019; 74: B447
        • Rahhab Z
        • Ren B
        • de Jaegere PPT
        • et al.
        Kissing balloon technique to secure the neo-left ventricular outflow tract in transcatheter mitral valve implantation.
        Eur Heart J. 2018; 39: 2220
        • Russell HM
        • Guerrero ME
        • Salinger MH
        • et al.
        Open atrial transcatheter mitral valve replacement in patients with mitral annular calcification.
        J Am Coll Cardiol. 2018; 72: 1437-1448
        • Barbanti M
        • Piazza N
        • Mangiafico S
        • et al.
        Transcatheter mitral valve implantation using the HighLife system.
        JACC Cardiovasc Interv. 2017; 10: 1662-1670
      3. Piazza N. The HIGHLIFE program: Attributes, challenges, and clinical data. Paper presented at: The Structural Heart Disease Summit (SHDS); June 20-23, 2018: Chicago, IL.

        • Aoi S
        • Wiley J, Ho
        • et al.
        Transcatheter tricuspid valve implantation with the Cardiovalve system.
        Future Cardiol. 2021; 17: 963-969
        • Maisano F
        • Benetis R
        • Rumbinaite E
        • et al.
        2-year follow-up after transseptal transcatheter mitral valve replacement with the Cardiovalve.
        JACC Cardiovasc Interv. 2020; 13: e163-e164
        • Alperi A
        • Val D
        • Ferreira-Neto AN
        • et al.
        Device profile of the AltaValve system for transcatheter mitral valve replacement: Overview of its safety and efficacy.
        Exp Rev Med Devices. 2020; 17: 627-636
        • Goel SS
        • Zuck V
        • Christy J
        • et al.
        Transcatheter mitral valve therapy with novel supra-annular AltaValve: First experience in the United States.
        JACC Case Rep. 2019; 1: 761-764
        • Webb JG
        • Murdoch DJ
        • Boone RH
        • et al.
        Percutaneous transcatheter mitral valve replacement: First-in-human experience with a new transseptal system.
        J Am Coll Cardiol. 2019; 73: 1239-1246
        • Makkar R
        • O'Neill W
        • Whisenant B
        • et al.
        Updated 30-day outcomes for the U.S. early feasibility study of the SAPIEN M3 Transcatheter Mitral Valve Replacement System.
        J Am Coll Cardiol. 2019; 74: B8
        • Webb J
        • Hensey M
        • Fam N
        • et al.
        Transcatheter mitral valve replacement with the transseptal EVOQUE system.
        JACC Cardiovasc Interv. 2020; 13: 2418-2426
      4. Clinicaltrials.gov. Edwards EVOQUE EOS mitral valve replacement: Investigation of safety and performance after mitral valve replacement with transcatheter device (MISCEND), 2021. Available at: https://clinicaltrials.gov/ct2/show/NCT02718001. Accessed February 17, 2022.

        • Alperi A
        • Dagenais F
        • del Val D
        • et al.
        Early experience with a novel transfemoral mitral valve implantation system in complex degenerative mitral regurgitation.
        JACC Cardiovasc Interv. 2020; 13: 2427-2437
        • Modine T
        • Vahl TP
        • Khalique OK
        • et al.
        First-in-human implant of the cephea transseptal mitral valve replacement system.
        Circ Cardiovasc Interv. 2019; 12e008003
        • Cheung A
        • Webb J
        • Verheye S
        • et al.
        Short-term results of transapical transcatheter mitral valve implantation for mitral regurgitation.
        J Am Coll Cardiol. 2014; 64: 1814-1819
        • Russo G
        • Gennari M
        • Gavazzoni M
        • et al.
        Transcatheter mitral valve implantation: Current status and future perspectives.
        Circ Cardiovasc Interv. 2021; 14e010628
        • Sorajja P
        • Gössl M
        • Babaliaros V
        • et al.
        Novel transcatheter mitral valve prosthesis for patients with severe mitral annular calcification.
        J Am Coll Cardiol. 2019; 74: 1431-1440
        • Sorajja P
        • Moat N
        • Badhwar V
        • et al.
        Initial feasibility study of a new transcatheter mitral prosthesis: The first 100 patients.
        J Am Coll Cardiol. 2019; 73: 1250-1260
      5. Clinicaltrials.gov. Clinical Trial to Evaluate the Safety and Effectiveness of Using the Tendyne Mitral Valve System for the Treatment of Symptomatic Mitral Regurgitation. Available at: https://clinicaltrials.gov/ct2/show/NCT03433274. Accessed February 17, 2022.

        • Cheung A.
        Early experience of TIARA transcatheter mitral valve replacement system.
        Ann Cardiothorac Surg. 2018; 7: 787-791
        • Conradi L.
        Innovative design of a transcatheter transapical mitral valve update on TIARA-I and TIARA-II clinical data.
        Paper presented at: Euro PCR; May 21-24. 2019; (Paris, France)
      6. Clinicaltrials.gov. Transcatheter Mitral Valve Replacement With the Medtronic Intrepid™ TMVR System in Patients With Severe Symptomatic Mitral Regurgitation - APOLLO Trial. Available at: https://clinicaltrials.gov/ct2/show/NCT03242642. Accessed February 17, 2022.

        • Bapat VN.
        Mitral valve-in-valve, valve-in-ring, and valve-in-mitral annular calcification: Are we there yet?.
        Circulation. 2021; 143: 117-119