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Interventional approaches to mitral regurgitation

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Interventionelle Ansätze bei Mitralklappenerkrankungen

Ein Blick in die Zukunft

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Abstract

Mitral regurgitation (MR) is the most prevalent valvular heart disease in the Western world. Surgical repair is the gold standard for the treatment of degenerative MR in low-risk patients. Given the rising number of patients with functional MR and higher operative risk due to relevant comorbidities and increasing age, interventional approaches to repair or replace diseased mitral valves are on the rise. However, the complex anatomy and physiology of the mitral valve and its adjacent valve apparatus bear major challenges. To date, only the MitraClip device has been used in a large number of patients; however, several other devices and systems specifically targeted at different underlying pathologies of MR are currently under development. In addition to valve repair, the first steps toward mitral valve replacement have been taken. The present article reviews the current state of the art of interventional approaches to mitral valve disease and its future perspectives.

Zusammenfassung

Die Mitralklappeninsuffizienz ist das häufigste Klappenvitium in der westlichen Welt. Die chirurgische Mitralklappenrekonstruktion ist der Goldstandard für Patienten mit degenerativer Mitralklappeninsuffizienz und niedrigem operativem Risiko. Durch die steigende Zahl von Patienten mit funktioneller Mitralklappeninsuffizienz sowie Patienten mit höherem operativem Risiko aufgrund von relevanten Komorbiditäten und zunehmendem Alter sind interventionelle Ansätze zur Reparatur sowie zum Ersatz von erkrankten Mitralklappen notwendig. Die komplexe Anatomie und Physiologie der Mitralklappe sowie des Mitralklappenapparats erschweren die Entwicklung interventioneller Strategien. Bisher wurde nur das MitraClip-System bei einer nennenswerten Anzahl von Patienten eingesetzt, jedoch werden im Moment verschiedene andere Systeme und Technologien entwickelt, die speziell auf verschiedene pathophysiologische Mechanismen ausgerichtet sind. Darüber hinaus wurden erste Schritte in Richtung eines interventionellen Mitralklappenersatzes unternommen. Die vorliegende Übersichtsarbeit stellt aktuelle Entwicklungen und Zukunftsperspektiven der interventionellen Mitralklappentherapie dar.

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Abbreviations

6MWT:

6-min walk test

CS:

coronary sinus

LA:

left atrium

LV:

left ventricle

LVOT:

left ventricular outflow tract

MV:

mitral valve

MR:

mitral regurgitation

DMR:

degenerative mitral regurgitation

FMR:

functional mitral regurgitation

TAVI:

transcatheter aortic valve implantation

TMV:

transcatheter mitral valve

TMVI:

transcatheter mitral valve implantation

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Authors and Affiliations

  1. Klinik für Kardiologie, Pneumologie, Angiologie und internistische Intensivmedizin, Herzzentrum Uniklinik Köln, Klinik III für Innere Medizin, Kerpener Str. 62, 50937, Cologne, Germany

    V. Mauri, S. Baldus &  V. Rudolph

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  1. V. Mauri
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  2. S. Baldus
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  3. V. Rudolph
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Correspondence to V. Rudolph.

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V. Mauri, S. Baldus, and V. Rudolph state that there are no conflicts of interest.

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Mauri, V., Baldus, S. & Rudolph, V. Interventional approaches to mitral regurgitation. Herz 41, 26–30 (2016). https://doi.org/10.1007/s00059-015-4384-2

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