Current status of transcatheter mitral valve repair therapies – From surgical concepts towards future directions

Figures & data

Figure 1. Mitral valve anatomy. The mitral valve comprises of the anterior and posterior leaflets, which are separated by the anterior commissure (AC) and the posterior commissure (PC). The leaflets are inserted on the circumference of the mitral annulus in continuity with the aortic annulus and the left and right fibrous trigones. mitral valve. Reprint with permission from Verma et al. [9].

Figure 2. Surgical repair techniques. Quadrangular or triangular incision of isolated prolapse of P2 (Panel A). The remaining parts of the posterior leaflet (P1 and P3) are approximated and an annuloplasty ring is used to stabilize the annulus, thus preventing progressive dilatation. Chordae tendineae replacement (Panel B) with an artificial Gore-Tex (ePTFE) sutures to substitute ruptured or elongated chordae. Edge-to-edge repair (Panel C) is performed by sewing the anterior and posterior leaflets together at the central points of their middle segments to correct anterior or bileaflet prolapse while leaving a double-orifice mitral valve. Reprint with permission from Verma et al. [9].

Table 1. Transcatheter mitral valve repair devices.

Target of therapy	Device	Access	Mechanism	Clinical status
Leaflet repair	Mitraclip (Abbott Vascular Inc, Santa Clara, CA)	Transvenous	Clip-based edge-to-edge repair (Figure 3)	CE mark 2008 FDA 2013 (pMR)
Chordal implantation	Neochord (Neochord, Minnetonka, MN)	Transapical	Chordal replacement with artificial chordae (Figure 4)	CE mark 2013
Indirect annuloplasty	Carillon (Cardiac Dimensions, Kirkland, WA)	Transjugular	Coronary sinus reshaping (Figure 5A)	CE mark 2009
Direct annuloplasty	Cardioband (Valtech, Yehuda, Israel) Mitralign (Mitralign, Tewksbury, MA)	Transvenous Transfemoral	Annuloplasty band with plicating anchors on mitral annulus (Figure 5B) Plicating anchors through posterior annulus	CE mark 2015 CE mark 2016

Figure 3. MitraClip (Abbott Vascular Inc, Santa Clara, CA) is a percutaneous mitral repair based on Alfieri edge-to-edge repair (see figure 2, panel C), designed for both degenerative and secondary MR.

Figure 4. Neochord (Neochord, Minnetonka, MN) chordal repair is a transapical beating heart approach for artificial chordae implantation designed for degenerative mitral valve prolapse.

Figure 5. Percutaneous mitral annuloplasty systems. Carillon (Cardiac Dimensions, Kirkland, WA) Indirect Annuloplasty (Panel A) is an implantable mitral annular constraint device percutaneously placed into the coronary sinus primarily designed for secondary MR (and potentially for primary MR). Cardioband (Valtech, Yehuda, Israel) Direct Annuloplasty (Panel B) is an annuloplasty band with plicating anchors on the atrial side of mitral annulus designed for secondary MR (and potentially for primary MR).

Verma S, Mesana TG. Mitral-valve repair for mitral-valve prolapse. N Engl J Med. 2009;361:2261–2269.

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