Transcatheter Repair of the Mitral Valve: Relevant Pathophysiology, Investigation and Management

Abstract Mitral regurgitation is a common condition causing significant morbidity and mortality in the western world. Although surgical therapy has developed over five decades to provide solutions, only a minority of patients undergo surgery for multiple reasons. The last decade has seen the emergence and application of multiple transcatheter techniques in attempts to address this undertreated population with the large clinical experience of MitraClip providing the most insight. Clear understanding of the pathophysiology of different MR types as well as the role of particularly secondary MR on patient's clinical syndrome allow for better prediction as to which patient subgroups will benefit from different repair techniques or intervention at all. Most of the techniques are sourced in surgical technique and are applied as single device/technique solutions, whether they be leaflet, chordal or annular solutions, however with broadening experience, combination therapies are likely to find a place in creating a more complete and surgical-like solution. Brief Summary: Mitral regurgitation is a common condition causing significant morbidity and mortality. The development of percutaneous mitral repair technologies has broadened the spectrum of treatable patients. Percutaneous translation of proven surgical techniques and improved understanding of specific mitral pathologies are the cornerstones of the progression of this burgeoning field. Patient specific device selection with the potential for combination therapies may offer improved outcomes for the patients suffering from a range of mitral pathologies.