DOI: 10.4244/EIJV11I6A121

The next step for mitral valve treatment: moving to early percutaneous intervention to prevent irreversible damage

Patrick W. Serruys, Editor-in-Chief

Patrick W. Serruys, Editor-in-Chief

I recently returned from the annual PCR London Valves meeting which this year was held in Berlin. As always, it was impressive to see this meeting consolidate its position as the premier meeting within the valvular interventional field. This year’s edition was no exception, with over 2,000 delegates attending. The choice of location was perhaps a little quirky, a little confusing. Gus Pichard told me that he landed in London and almost forgot to catch his transfer to Berlin as the PCR Valves meeting has become so synonymous with London. For others, it was sometimes strange to talk about “London” while we were in Berlin.

William Wijns, in his opening speech as chairman of PCR, took the opportunity of the temporary relocation to pay tribute to the German cardiologists who have put aortic valve interventions on the map. Together with the recent EEP publication in EuroIntervention1, many of our colleagues were fully aware of these impressive achievements.

Sunday was a very busy day, mainly focusing on technical aspects, which were of a very high quality; however, the opening case on Monday was the real highlight for me. Hussein Ince gave a fabulous demonstration of “MitraClipping”, working fully under imaging control, like a master tailor from London’s Savile Row. One could see perfectly the clip and the mitral valve in 2D and 3D while he was working perpendicular to the line of coaptation. The result of the first clip was spectacular; nevertheless, a small colourful flame of very limited regurgitation was evident and, with great composure and grace, he told us he needed to implant a second clip. Personally, I was worried, but Hussein knew exactly what he was doing and, after the second clip, no regurgitation was found. As he worked basically as a solo operator, the case went quickly. In fact, the panel had to fill the remaining time with what turned out to be a very enlightening discussion.

This case set the tone for the whole meeting. Immediately after, Maurice Enriquez-Sarano gave the keynote lecture entitled “Mitral regurgitation: a disease of the valve and myocardium. When and how should we intervene?”. Maurice was very convincing, demonstrating that in the future we will probably have to treat the anatomic disease before specific early functional signs of deterioration appear. In other words, we should not treat the patient only when the symptoms are evident but treat the disease before irreversible functional deterioration appears. This message is so important since in the past to submit an individual to the “surgical operative shock” was a major decision, whilst nowadays percutaneous treatment allows us to mimic the act of the surgeon without the aggression of opening the chest.

I do not wish to trivialise the percutaneous treatment of the aortic valve, but my perception was that in many talks the following three themes emerged repeatedly – low-risk, all-comers, and patients older than 60 years. Finally, we have to give credit to surgeons in the sense that all the creative treatments that they have applied to patient care are now mimicked by the treatment of the interventionalist, for example annuloplasty, duplicating the Alfieri technique, reducing the dimension of the left ventricle and the atrial cavity, and so on. These surgical skills are now becoming doable and feasible with percutaneous techniques and they facilitate early anatomic correction before the onset of functional deterioration. From that point of view, I found the meeting enlightening. I would be very surprised if progress were not readily made in the field of mitral interventions, despite the much more complex challenges in pathology.

Reference

Volume 11 Number 6
Oct 20, 2015
Volume 11 Number 6
View full issue


Key metrics

On the same subject

EAPCI Column

Feb 5, 2024
EAPCI at PCR London Valves 2023
free

10.4244/EIJV12I9A179 Oct 20, 2016
EAPCI: the home for the world’s valvular community
Haude M
free

10.4244/EIJV13I10A178 Nov 20, 2017
PCR London Valves Innovators Day 2017. Where will valve intervention be in 2025?
Dawkins S et al
free

10.4244/EIJV14SABA1 Sep 7, 2018
Welcome to PCR London Valves 2018: 10th Anniversary Edition
Barbanti M et al
free

10.4244/EIJV15I10A154 Nov 15, 2019
2019 – A leap year for valvular heart disease
Tamburino C et al
free

10.4244/EIJV12SYA1 Sep 18, 2016
Welcome to PCR London Valves 2016: back to the UK
Tamburino C et al
free

10.4244/EIJV12I2A25 Jun 10, 2016
PCR Innovators Day: dreaming with our eyes wide open…
Wijns W et al
free
Trending articles
281.53

State-of-the-Art Review

10.4244/EIJ-D-21-00695 Nov 19, 2021
Transcatheter treatment for tricuspid valve disease
Praz F et al
free
243.2

State of the art

10.4244/EIJ-D-21-01117 Sep 20, 2022
Recanalisation of coronary chronic total occlusions
Di Mario C et al
free
208.35

State-of-the-Art Review

10.4244/EIJ-D-21-01034 Jun 3, 2022
Management of in-stent restenosis
Alfonso F et al
free
168.7

Translational research

10.4244/EIJ-D-21-00824 May 15, 2022
Bench test and in vivo evaluation of longitudinal stent deformation during proximal optimisation
Toth GG et al
free
167.05

Expert review

10.4244/EIJ-D-21-00690 May 15, 2022
Crush techniques for percutaneous coronary intervention of bifurcation lesions
Moroni F et al
free
151.03

State-of-the-Art

10.4244/EIJ-D-22-00776 Apr 3, 2023
Computed tomographic angiography in coronary artery disease
Serruys PW et al
free
118

Translational research

10.4244/EIJ-D-22-00718 Jun 5, 2023
Preclinical evaluation of the degradation kinetics of third-generation resorbable magnesium scaffolds
Seguchi M et al
110.35

Viewpoint

10.4244/EIJ-E-22-00007 May 15, 2022
TAVI at 20: how a crazy idea led to a clinical revolution
Eltchaninoff H et al
free
X

The Official Journal of EuroPCR and the European Association of Percutaneous Cardiovascular Interventions (EAPCI)

EuroPCR EAPCI
PCR ESC
Impact factor: 6.2
2022 Journal Citation Reports®
Science Edition (Clarivate Analytics, 2023)
Online ISSN 1969-6213 - Print ISSN 1774-024X
© 2005-2024 Europa Group - All rights reserved