Catheter-based mitral valve reconstruction. State of the art and perspectives

Background. Due to advanced age and multimorbidity, approximately one third of patients with relevant mitral regurgitation are not referred for surgery. Recently developed catheter-based percutaneous reconstruction techniques are gaining in importance due to reduced invasiveness. Aim. Based on the results of recent studies this article presents a review of the currently available procedures, the possibilities of application and risks. Material and methods. The three procedures currently approved for clinical application in Germany are the MitraClip, the NeoChord DS1000 and the CARILLON (R) system. These procedures are presented following an introduction on the pathomechanism, sequelae, course and indications for surgery of the European Society of Cardiology. Special emphasis is given to the individual methods, the results of recently published studies and potential complications. Results. Studies have confirmed a significant reduction in mitral valve regurgitation and an improved survival rate for the described procedures in comparison to pharmaceutical therapy alone. Conclusion. These catheter-based approaches to mitral valve reconstruction offer an alternative therapy option in the future for multimorbid high risk patients who have been assessed as inoperable by an interdisciplinary heart team. However, due to the excellent results of surgical reconstruction the use of these methods should be reserved for the specifically named groups of patients. Based on the early stage of application the long-term durability of catheter-based technologies needs to be assessed in the future.