Transcatheter Mitral Valve Repair and Replacement in Degenerative Mitral Regurgitation: Evolution of Treatment Strategies

Laneash De Sousa; Khin May Phoo Thwe; Akshaya Indrakumar

doi:10.33178/SMJ.2026.2

Authors

Laneash De Sousa University College Cork
Khin May Phoo Thwe
Akshaya Indrakumar

DOI:

https://doi.org/10.33178/SMJ.2026.2

Keywords:

Degenerative Mitral Regurgitation, Transcatheter Mitral Valve Repair

Abstract

Abstract

The prevalence of Degenerative Mitral Regurgitation (DMR) has been increasing globally over the recent decades. It is a disorder that predominantly affects the older generation, this generation however is also affected by many other comorbidities. As a result, they are classified as being too high-risk for the conventional treatment of DMR which is surgical intervention. In the past their treatment options were limited. However, with the development of Transcatheter Mitral Valve Repair (TMVr) techniques this cohort of patients is able to receive interventions that are minimally-invasive. These interventions have been proven to decrease the severity of mitral regurgitation whilst also improving the patient’s quality of life. They are also associated with better long-term outcomes compared to patients receiving medical treatment alone.

This review focuses on the role of Transcatheter Mitral Valve repair in the Treatment of degenerative mitral valve in surgically high-risk patients.

References

1. Delgado V, Ajmone Marsan N, Bonow RO, Hahn RT, Norris RA, Zühlke L, et al. Degenerative mitral regurgitation. Nat Rev Dis Primers [Internet]. 2023 Dec 7;9(1):70. Available from: https://pubmed.ncbi.nlm.nih.gov/38062018/

2. Chan N, Dong T, Sabbak N, Xu B, Wang TKM. Contemporary Review of Transcatheter Mitral Valve Interventions for Mitral Regurgitation [Internet]. Vol. 13, Life (Basel, Switzerland). Switzerland; 2023.p. 1511. Available from: https://pubmed.ncbi.nlm.nih.gov/37511886/

3. Dębski M, Qadri S, Bhalraam U, Dębska K, Vassiliou V, Zacharias J. Comparison of mitral valve repair vs. replacement for mitral valve regurgitation. Eur Heart J Qual Care Clin Outcomes [Internet]. 2025 Aug 11;11(5):587–603. Available from: https://pubmed.ncbi.nlm.nih.gov/39775859/

4. Makkar RR, Chikwe J, Chakravarty T, Chen Q, O’Gara PT, Gillinov M, et al. Transcatheter mitral valve repair for degenerative mitral regurgitation. JAMA. 2023 May 23;329(20):1778–8.

5. Antoine C, Mantovani F, Benfari G, Mankad SV, Maalouf JF, Michelena HI, et al. Pathophysiology of Degenerative Mitral Regurgitation: New 3-Dimensional Imaging Insights. Circ Cardiovasc Imaging [Internet]. 2018;11(1):e005971. Available from: https://pubmed.ncbi.nlm.nih.gov/29321211/

6. Levine RA, Hagége AA, Judge DP, Padala M, Dal-Bianco JP, Aikawa E, et al. Mitral valve disease—Morphology and mechanisms. Nature reviews Cardiology [Internet]. 2015 Dec;12(12):689–710. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4804623/#:~:text=The%20spongiosa%20is%20thicker%20at

7. Coutinho GF, Antunes MJ. Current status of the treatment of degenerative mitral valve regurgitation. Revista Portuguesa de Cardiologia. 2021 Apr;40(4):293–304.

8. Regueiro A, Granada JF, Dagenais F, Rodés-Cabau J. Transcatheter mitral valve replacement. Journal of the American College of Cardiology [Internet]. 2017 May;69(17):2175–92. Available from: https://www.sciencedirect.com/science/article/pii/S0735109717359697?via%3Dihub

9. Niikura H, Gössl M, Kshettry V, Olson S, Sun B, Askew J, et al. Causes and clinical outcomes of patients who are ineligible for transcatheter mitral valve replacement. JACC Cardiovasc Interv [Internet]. 2019 Jan 28;12(2):196–204. Available from: https://pubmed.ncbi.nlm.nih.gov/30678799/

10. Rolando M, Affronti A, Loreni F, Marcello Bergonzini, Carluccio E, Fortuni F. Mitral valve repair in the modern era: Insights into techniques and technologies with a glimpse of the future. Journal of Clinical Medicine. 2025 Oct 14;14(20):7251–1.

11. Kotit S. The MATTERHORN trial: Percutaneous MitraClip vs surgical repair in heart-failure-related secondary mitral regurgitation. Glob Cardiol Sci Pract [Internet]. 2025 Feb 28;2025(1):e202502. Available from: https://pubmed.ncbi.nlm.nih.gov/40390996/

12. Arnautovic JZ, Ya’Qoub L, Wajid Z, Jacob C, Murlidhar M, Damlakhy A, et al. Outcomes and complications of mitral and tricuspid transcatheter edge-to-edge repair. Interv Cardiol [Internet]. 2024 Oct 28;19:e20. Available from: https://pubmed.ncbi.nlm.nih.gov/39569385/