Transcatheter devices for direct annuloplasty and chordal replacement in degenerative mitral regurgitation

摘要

The two main principles of surgical mitral valve (MV) repair for primary mitral regurgitation (MR) are underpinned by restoration of the chordal support to the free edge of the leaflet, most often by leaflet resection or chordal replacement, and annuloplasty to reverse or prevent annular dilatation. The success and durability of this operation, when performed well, is best illustrated in the long-term follow-up series by David and Carpentier (1,2). Within the last decade, transcatheter therapies have increasingly attempted to duplicate the superb surgical outcomes for primary MR. Most notably, the transseptal MitraClip (Abbott, Abbott Park, IL, USA) technology has replicated Alfieri’s “edge-to-edge” repair and is used worldwide with more than 100,000 implants. In the U.S., MitraClip is available in patients with primary MV disease for those patients who are at too high-risk for traditional MV surgery. Although MitraClip is used commonly in Europe for secondary MR, it is anticipated that usage in the U.S. for this indication will occur soon with the positive results of the recently published COAPT trial (3). There are no commercially available options available for transcatheter MV replacement; however, several devices are in early feasibility study (EFS) or pivotal trials worldwide (4). Herein, we briefly review emerging transcatheter technologies with published trial data aiming to replicate chordal replacement and annuloplasty techniques of primary MR.