Figure 1.
Challenges in the successful development of a transcatheter mitral valve replacement (TMVR) device. Multiple interrelated factors influence the optimal positioning and performance of a TMVR device. PVL: paravalvular leak; LVOT: left ventricular outflow tract; LCx: left circumflex artery. Adapted from De Backer et al.12
Table 1.
Salient features of current transcatheter mitral valve replacement (TMVR) platforms. Comparison of relevant features pertaining to device design, anchoring mechanism, delivery approach, and sheath size.
Table 2.
Current experience and status of clinical programs with transcatheter mitral valve replacement platforms. Adapted from Krishnaswamy et al.14
Figure 2.
Transapical (TA) transcatheter mitral valve replacement preprocedural planning and device deployment. Panel I (A–F) illustrates preprocedural planning with emphasis on computed tomography (CT) overlay and predicting device anchoring and effect on left ventricular outflow tract (LVOT) dimensions. Panel II (A–C) illustrates use of CT techniques to predict TA access site and sheath trajectory. Panel III (A–E) demonstrates TA access, device deployment, and postdeployment echo assessment.
Figure 3.
Transseptal (TS) transcatheter mitral valve replacement procedural steps. Panel I (A–H) shows dual transseptal puncture and balloon tracking. Panel II (A–F) shows device tracking and deployment. Panel III (A–D) shows device evaluation postdeployment.13
Figure 4.
(A) Transcatheter mitral valve-in-valve/valve-in-ring (ViV/ViR) fluoroscopic image of a 28-mm Edwards Physio 1 ring (Edwards Lifesciences Corporation). (B) Final fluoroscopic image after the implantation of a 23-mm Edwards SAPIEN XT transcatheter heart valve inside the ring (ViR procedure) via a transapical approach. (C) Fluoroscopic image of a failing 23-mm Mosaic valve (Medtronic) in the mitral position. (D) Postprocedural fluoroscopic image showing a 23-mm Edwards SAPIEN XT transcatheter heart valve implanted within the surgical heart valve through a transapical route.19
Figure 5.
Transcatheter mitral valve replacement for degenerative mitral stenosis. (A) Images are for patients 1 to 4 in respective columns (1A, 2A, 3A, 4A). Computed tomography of mitral annular calcifications. (1B) Three-dimensional transesophageal echocardiography of valve implantation within the mitral annulus. (2B-4B) Fluoroscopy of valve implantation within the mitral annulus. (1C-4C) Computed tomography postimplantation. (1D) Three-dimensional echocardiography postimplantation. (2D-4D) Two-dimensional echocardiography postimplantation.25
Table 3.
Published reports of transcatheter mitral valve replacement in degenerative mitral stenosis, including clinical presentation, device details, and follow-up. Adapted from Guerrero et al.26
