Treatment of mitral valve disease is a very common condition, affecting about 3% of the population. Recent years have seen major advances in minimally invasive mitral valve surgery and several new catheter-based techniques are being clinically evaluated. Indeed, percutaneous therapy has emerged as an option for treatment of mitral valve disease including regurgitation and prolapse for selected, predominantly high-risk patients.
Many patients with symptomatic, severe mitral regurgitation never undergo surgery due to a deemed excessive surgical risk and complete endovascular surgery is therefore an exciting alternative for these patients. Several technologies are being investigated, most of them based on long-standing surgical techniques. Over 1,000 patients have been treated worldwide with the Mitraclip system for leaflet plication, for example. This device has gained the CE mark and there has been a shift in the spectrum of candidates suitable for this technique, as recent experiences have shown that adverse mitral anatomies and functional MR patients may also benefit from this form of complete endovascular surgery and device.
An overview of recent technology for mitral heart disease can be found on Radcliffe Cardiology’s website which has a strong focus on cardiologist education. Anatomic evaluation seems crucial in order to select the most suitable patient for the procedure and cardiac computed tomography angiography is probably the best tool for patient selection. Indeed, mitral regurgitation is a complex disease with many aetiologies and pathophysiologies and therefore it seems unlikely that a single device can fix the problem. The first challenge is in fact to really understand MV disease which is why focus on education for cardiologists is so important, then a combination of techniques will be necessary for a
satisfactory MR repair. Close collaboration between interventional cardiologists, cardiac surgeons, imaging cardiologists, basic scientists and the industry is essential for these technologies to progress and become a real alternative for this group of patients.
