Durability of transcatheter mitral valve replacement: another step forward

Transcatheter therapies for mitral regurgitation (MR) enable the treatment of patients who are unsuitable or at high risk for surgery. Transcatheter edge-to-edge repair (TEER) is the first-line therapy in patients with secondary ventricular MR, but it is also indicated for patients with primary MR and atrial secondary MR1. However, the use of TEER remains limited by some unfavourable anatomical characteristics (i.e., a very short posterior leaflet, small valve area, complex anatomies). Furthermore, suboptimal TEER results are known to be strongly related with worse clinical outcomes2. Thus, careful anatomical selection and availability of dedicated transcatheter mitral valve replacement (TMVR) systems are crucial in the management of high-risk patients with MR23.

In the last decade, the development of TMVR has been slower than anticipated because of several challenges: delivery catheter sizing, anchoring design, risk of left ventricular outflow tract (LVOT) obstruction, thrombogenicity, and durability.

Today, we are finally turning the corner. Advances in technologies have led to the development of safe and effective devices. Currently, two prostheses are approved for commercial use in Europe (Tendyne [Abbott] and SAPIEN M3 [Edwards...