Screening for TMVR: A Glimpse into the Future Technological Needs and Requirements

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 . 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 slowing 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.