title: Transcatheter Mitral Valve Repair Therapies: Evolution, Status and Challenges.
abstract: Mitral regurgitation is a common cardiac valve lesion, developing from primary lesions of the mitral valve or secondary to cardiomyopathies. Moderate or higher severity of mitral regurgitation imposes significant volume overload on the left ventricle, causing permanent structural and functional deterioration of the myocardium and heart failure. Timely correction of regurgitation is essential to preserve cardiac function, but surgical mitral valve repair is often delayed due to the risks of open heart surgery. Since correction of mitral regurgitation can provide symptomatic relief and halt progressive cardiac dysfunction, transcatheter mitral valve repair technologies are emerging as alternative therapies. In this approach, the mitral valve is repaired either with sutures or implants that are delivered to the native valve on catheters introduced into the cardiovascular system under image guidance, through small vascular or ventricular ports. Several transcatheter mitral valve technologies are in development, but limited clinical success has been achieved. In this review, we present a historical perspective of mitral valve repair, review the transcatheter technologies emerging from surgical concepts, the challenges they face in achieving successful clinical application, and the increasing rigor of safety and durability standards for new transcatheter valve technologies.
authors.affiliation: Structural Heart Research & Innovation Laboratory, Division of Cardiothoracic Surgery, Carlyle Fraser Heart Center, Emory University School of Medicine, 380-B Northyards Blvd, Atlanta, GA, 30313, USA.
authors.forename: Daniella
authors.initials: D
authors.lastname: Espiritu
authors.affiliation: Structural Heart Research & Innovation Laboratory, Division of Cardiothoracic Surgery, Carlyle Fraser Heart Center, Emory University School of Medicine, 380-B Northyards Blvd, Atlanta, GA, 30313, USA.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Onohara
authors.affiliation: Structural Heart Research & Innovation Laboratory, Division of Cardiothoracic Surgery, Carlyle Fraser Heart Center, Emory University School of Medicine, 380-B Northyards Blvd, Atlanta, GA, 30313, USA.
authors.forename: Kanika
authors.initials: K
authors.lastname: Kalra
authors.affiliation: Structural Heart Research & Innovation Laboratory, Division of Cardiothoracic Surgery, Carlyle Fraser Heart Center, Emory University School of Medicine, 380-B Northyards Blvd, Atlanta, GA, 30313, USA.
authors.forename: Eric L
authors.initials: EL
authors.lastname: Sarin
authors.affiliation: Structural Heart Research & Innovation Laboratory, Division of Cardiothoracic Surgery, Carlyle Fraser Heart Center, Emory University School of Medicine, 380-B Northyards Blvd, Atlanta, GA, 30313, USA. spadala@emory.edu.
authors.forename: Muralidhar
authors.initials: M
authors.lastname: Padala
mesh_terms: D000818:Animals; D006328:Cardiac Catheterization / Q000295:instrumentation / Q000379:methods; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000295:instrumentation / Q000379:methods; D006801:Humans; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000601:surgery; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging / Q000601:surgery