About this Research Topic
The field of Transcatheter Mitral Valve Replacement (TMVR) is in an early stage of development with important challenges encountered in the initial experience. TMVR has been found to be more technically difficult than Transcatheter Aortic Valve Replacement (TAVR). The complexity of the mitral valve apparatus anatomy is requiring high quality engineering of the dedicated devices.
The saddle-oval shape of the mitral annulus, large size, mitral valve leaflet interaction with surrounding structures that increase risk of left ventricular outflow tract obstruction are extremely cumbersome in the development of an appropriate replacement system. Furthermore, the durability of the neo-leaflets and the metallic frame are exposed to the typical biomechanical forces of the contracting ventricle and deforming annulus. The fixation of the device, as opposed to TAVR, is rather challenging. Finally, the access route for these large bore devices are currently limited to mostly apical approach, resulting in a higher risk of periprocedural complications and 30-day mortality.
While TMVR technology has great clinical potential for surgically inoperable patients suffering from mitral regurgitation, no transcatheter valve design has yet achieved regulatory approval. The diversity of devices currently under development reflects a lack of consensus regarding optimal design approaches. An important goal for robust TMV design is maximizing the likelihood of achieving a geometry post-implant that facilitates optimal performance.
The aim of this Research Topic is to provide an overview of the current devices, their specific features, and potential complications as well.
The saddle-oval shape of the mitral annulus, large size, mitral valve leaflet interaction with surrounding structures that increase risk of left ventricular outflow tract obstruction are extremely cumbersome in the development of an appropriate replacement system. Furthermore, the durability of the neo-leaflets and the metallic frame are exposed to the typical biomechanical forces of the contracting ventricle and deforming annulus. The fixation of the device, as opposed to TAVR, is rather challenging. Finally, the access route for these large bore devices are currently limited to mostly apical approach, resulting in a higher risk of periprocedural complications and 30-day mortality.
While TMVR technology has great clinical potential for surgically inoperable patients suffering from mitral regurgitation, no transcatheter valve design has yet achieved regulatory approval. The diversity of devices currently under development reflects a lack of consensus regarding optimal design approaches. An important goal for robust TMV design is maximizing the likelihood of achieving a geometry post-implant that facilitates optimal performance.
The aim of this Research Topic is to provide an overview of the current devices, their specific features, and potential complications as well.
Keywords: Mitral valve, Percutaneous mitral valve replacement, TMVR, Mitral regurgitation, Intervention
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