Catheter-based versus surgical mitral valve intervention: choosing between the red pill and the blue pill

Transcatheter mitral valve (MV) implantation (TMVI) for the treatment of severe mitral regurgitation (MR) has attracted increased interest in recent years. Several dedicated devices are being developed and trialled despite facing technical challenges due to the anatomical complexity of the MV and its proximity to other cardiac structures. Screening failure has been reported to be close to 60% in a study assessing 11 different TMVI devices1. Furthermore, the appropriate use of TMVI is yet to be established, and many available devices have a paucity of data to support their use (Supplementary Table 1).

The transapical, tether‐based Tendyne Mitral Valve System (Abbott) has emerged as a forerunner in the TMVI field. The 30-day, 1- and 2-year outcomes of 100 high surgical risk patients have been reported in a single-arm global feasibility study, showing a technical success rate (<1+ MR at 30 days) of 96% with sustained results at 1 and 2 years, while also reducing hospitalisations for heart failure23. These results in a high-risk population prompted the approval of the Tendyne device for commercial use in Europe...