Transcatheter aortic valve replacement (TAVR) has transformed the care of patients with aortic stenosis. The dissemination of this technology after its approval in the United States in the wake of a pivotal randomised trial has thus far proceeded in a thoughtful and circumspect manner, guided by a coalition of stakeholders dedicated to the delivery of high-quality, patient-centered care.
It is anticipated that a number of transcatheter therapies for mitral regurgitation (MR) will also become available for clinical use in selected patients. As an example, the MitraClip device (Abbott Vascular, Santa Clara, California) was approved October 24, 2013, for the reduction of significant (â‰¥3+), symptomatic, degenerative MR in highly anatomically selected patients considered by an experienced heart team to be at prohibitive risk for mitral valve surgery. Other transcatheter approaches in development include mitral annulusâ€“based therapies, transapical neochordal implants, valve-in-valve and valve-in-annuloplasty ring therapies, and valve replacement therapies.
A process similar to that adopted for TAVR is proposed to ensure that such innovative treatments are introduced into medical practice in the United States with appropriate safeguards. The American College of Cardiology (ACC), the American Association for Thoracic Surgery (AATS), The Society of Thoracic Surgeons (STS), and the Society of Cardiovascular Angiography and Interventions (SCAI) Foundation have collaborated to write this overview to set the stage for an ensuing series of documents, to be joined by other professional societies, and to address the issues critical to the appropriate integration of transcatheter MR therapies into the care of selected patients with this disorder.