Current Percutaneous Treatment of Mitral Valve Diseases
Seance of wednesday 03 february 2021 (Prise en charge interventionnelle coeur)
DOI number : 10.26299/bprr-9b62/emem.2018.4.020
Abstract
Driven by the worldwide success of transcatheter aortic valve implantation, percutaneous mitral valve interventions progressively developed during the last decade. There is a clinical need due to the demographic trends and the increasing management of elderly patients at high risk or contraindicated for surgery. There are divided into repair and replacement techniques.
The edge-to-edge repair using the MitraClip device, which mimics the Alfieri surgical technique, is largely used in current clinical practice, with an excellent benefit/risk ratio. Its indications are high-risk patients with primary, degenerative mitral failure and selected patients with secondary mitral failure.
Although promising, percutaneous direct mitral annuloplasty is technically demanding and restricted to few centers. Percutaneous mitral valve replacement can be considered in 2 clinical settings: 1) In patients with mitral failure on native, non-calcified mitral valves, dedicated devices can be used but remain restricted to research or compassionate use. 2) In patients with bioprosthesis deterioration, annuloplasty failure or mitral valve disease with severe mitral annulus calcification, balloon-expandable transcatheter aortic prostheses can be used in clinical practice.
Paravalvular leaks raise difficult therapeutic issues, which may find solutions with the use of percutaneous closure devices. Finally, percutaneous mitral commissurotomy has been used since the eighties and remains the first-line treatment of rheumatic mitral stenosis.
The edge-to-edge repair using the MitraClip device, which mimics the Alfieri surgical technique, is largely used in current clinical practice, with an excellent benefit/risk ratio. Its indications are high-risk patients with primary, degenerative mitral failure and selected patients with secondary mitral failure.
Although promising, percutaneous direct mitral annuloplasty is technically demanding and restricted to few centers. Percutaneous mitral valve replacement can be considered in 2 clinical settings: 1) In patients with mitral failure on native, non-calcified mitral valves, dedicated devices can be used but remain restricted to research or compassionate use. 2) In patients with bioprosthesis deterioration, annuloplasty failure or mitral valve disease with severe mitral annulus calcification, balloon-expandable transcatheter aortic prostheses can be used in clinical practice.
Paravalvular leaks raise difficult therapeutic issues, which may find solutions with the use of percutaneous closure devices. Finally, percutaneous mitral commissurotomy has been used since the eighties and remains the first-line treatment of rheumatic mitral stenosis.