Purpose of Review

We aimed to picture the contemporary landscape of available catheter-based repair and replacement solutions for mitral regurgitation (MR) in Europe.

Recent Findings

Edge-to-edge repair remains the dominant technique for transcatheter mitral valve repair especially in the context of secondary mitral regurgitation. Two recent randomized trials reported seemingly contradicting clinical results with transcatheter edge-to-edge repair for patients with heart failure and severe secondary MR. A proportionality framework related to secondary MR was proposed to help explain inconsistencies but requires further research. (In)Direct annuloplasty primarily aims to correct secondary MR; however, the scientific basis seems less robust. One dedicated transcatheter heart valve has the CE mark for mitral valve replacement but requires transapical access. Balloon-expandable transcatheter aortic valve platforms are emerging for transvenous transseptal mitral replacement in the context of mitral annular calcification, a failing surgical mitral bioprosthesis, or annuloplasty. Advanced computed tomography imaging techniques improved pre-procedural planning and introduced the option for modeling and simulation.

Summary

Development of a toolbox of catheter-based technologies, complementary imaging modalities, and refined patient selection offer novel perspectives to high-risk patients with primary or secondary MR. Clinical trials are required to help formulate evidence-based guidelines for the management of mitral valve disease.

中文翻译：

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二尖瓣反流的经导管修复和置换技术：欧洲视角

审查目的

我们的目标是描绘欧洲现有的基于导管的二尖瓣反流 (MR) 修复和更换解决方案的现状。

最近的发现

边缘到边缘修复仍然是经导管二尖瓣修复的主要技术，尤其是在继发性二尖瓣关闭不全的情况下。最近的两项随机试验报告了经导管边缘到边缘修复对心力衰竭和严重继发性 MR 患者的临床结果似乎相互矛盾。提出了与二级 MR 相关的比例框架以帮助解释不一致之处，但需要进一步研究。(In) 直接瓣环成形术主要旨在矫正继发性 MR；然而，科学依据似乎不那么可靠。一个专用的经导管心脏瓣膜具有用于二尖瓣置换的 CE 标志，但需要经心尖进入。在二尖瓣环钙化的情况下，球囊扩张式经导管主动脉瓣平台正在出现，用于经静脉经间隔二尖瓣置换术，失败的外科二尖瓣生物假体或瓣环成形术。先进的计算机断层扫描成像技术改进了术前计划并引入了建模和模拟选项。

概括

开发基于导管技术的工具箱、互补的成像方式和完善的患者选择为原发性或继发性 MR 的高危患者提供了新的视角。需要临床试验来帮助制定基于证据的二尖瓣疾病管理指南。