Transcatheter mitral valve interventions have been developed to correct primary mitral regurgitation either through a transseptal or a transapical approach. Among the transcatheter procedures, currently only the edge-to-edge mitral repair is widely adopted.¹²⁹ Experience with transcatheter annuloplasty, transapical chordal implantation or valve replacement is still limited and general recommendations cannot yet be made. Transcatheter mitral valve treatment should be discussed by the Heart Team in symptomatic patients who are at high surgical risk or are inoperable. Percutaneous edge-to-edge repair is generally safe and can improve symptoms and provide reverse LV remodelling. However, the rate of residual mitral regurgitation up to 5 years is higher than with surgical repair.¹³⁰

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Indications for intervention in severe primary mitral regurgitation

BSA = body surface area; LA = left atrial; LV = left ventricular; LVEF = left ventricular ejection fraction; LVESD = left ventricular end-systolic diameter; SPAP = systolic pulmonary artery pressure.

a

Class of recommendation.

b

Level of evidence.

c

Cut-offs refer to average-size adults and may require adaptations in patients with unusually small or large stature.

d

If an elevated SPAP is the only indication for surgery, the value should be confirmed by invasive measurement.

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Indications for intervention in severe primary mitral regurgitation

BSA = body surface area; LA = left atrial; LV = left ventricular; LVEF = left ventricular ejection fraction; LVESD = left ventricular end-systolic diameter; SPAP = systolic pulmonary artery pressure.

a

Class of recommendation.

b

Level of evidence.

c

Cut-offs refer to average-size adults and may require adaptations in patients with unusually small or large stature.

d

If an elevated SPAP is the only indication for surgery, the value should be confirmed by invasive measurement.