The development of transcatheter therapies has expanded the therapeutic reach to high-risk patients with severe mitral regurgitation (MR). In this patient population, transcatheter edge-to-edge repair (TEER) is the only clinically approved procedure with more than 150,000 patients treated to date. Amongst these real-world cases, nearly half do not have COAPT-like enrollment criteria, and a substantial proportion is left untreated due to anatomical reasons limiting the success of TEER
1. In recent years, transcatheter mitral valve replacement (TMVR) is emerging as an alternative solution for these patients promising the advantage of being “agnostic” to the underlying mitral valve pathology. Each individual TMVR device displays unique structural design features and mechanisms of delivery, thus, patient screening with multi-modality imaging is a critical step in ensuring procedural suitability. The goal of pre-procedural imaging is primarily to assess mitral annular sizing and surrounding tissues’ morphology according to the device’s needs and to identify any other potential challenges that may impact the success of the procedure. As a result of this selective process, only a minority of the patients screened are deemed to be eligible for TMVR
- Scotti A
- Munafò A
- Adamo M
- et al.
Transcatheter Edge-to-Edge Repair in COAPT-Ineligible Patients: Incidence and Predictors of 2-Year Good Outcome.
Can J Cardiol. 2022; 38: 320-329https://doi.org/10.1016/j.cjca.2021.12.003
2slowing enrollment in clinical trials and the progress of the field. Understanding the root causes behind these rejections is fundamental to identify the ongoing clinical challenges, future design needs, and expand TMVR adoption.
- Ludwig S
- Ruebsamen N
- Deuschl F
- et al.
Screening for transcatheter mitral valve replacement: a decision tree algorithm.
EuroIntervention. 2020; 16: 251-258https://doi.org/10.4244/EIJ-D-19-01051
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- Transcatheter Edge-to-Edge Repair in COAPT-Ineligible Patients: Incidence and Predictors of 2-Year Good Outcome.Can J Cardiol. 2022; 38: 320-329https://doi.org/10.1016/j.cjca.2021.12.003
- Screening for transcatheter mitral valve replacement: a decision tree algorithm.EuroIntervention. 2020; 16: 251-258https://doi.org/10.4244/EIJ-D-19-01051
- Clinical characteristics and outcomes of patients screened for but DEemed CLInically Not suitablE for Transcatheter Mitral Valve Replacement.Canadian Journal of Cardiology. 2023; 0https://doi.org/10.1016/j.cjca.2023.01.017
- Transcatheter mitral valve replacement: factors associated with screening success and failure.EuroIntervention. 2019; 15: e983-e989https://doi.org/10.4244/EIJ-D-19-00444
Accepted: March 5, 2023
Received in revised form: March 1, 2023
Received: February 23, 2023
Publication stageIn Press Journal Pre-Proof
Disclosures: AS has served as a consultant and received consulting fees from NeoChord Inc., AC has served as a consultant for Abbott and received speaker fees from Abbott and GE Healthcare.
© 2023 Published by Elsevier Inc. on behalf of the Canadian Cardiovascular Society.
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- Clinical characteristics and outcomes of patients screened for but DEemed CLInically Not suitablE for Transcatheter Mitral Valve ReplacementCanadian Journal of Cardiology
- PreviewTranscatheter therapies are a recognized alternative intervention in patients with severe mitral regurgitation who are at high surgical risk. The purpose of this study was to characterize patients screened for transcatheter mitral valve replacement (TMVR), establish the clinical and anatomical reasons for unsuitability, and determine clinical course and early outcomes.