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Page 10 of 12 Cepas-Guillen et al. Vessel Plus 2021;5:26 https://dx.doi.org/10.20517/2574-1209.2020.79

Multi-slice cardiac CT is used to assess the potential for LVOT obstruction and the degree of mitral annular
calcification [50,51] .

Mitral regurgitation is often coexistent with other cardiac disease, such as tricuspid regurgitation, severe
[48]
pulmonary hypertension, and severe left ventricle disfunction . Despite the increasing availability of
TMVR, patients with severe mitral regurgitation may not be eligible. Niikura et al. showed that the
[52]
ineligibility rate for TMVR is usually very high (89.0%). The most common reasons for TMVR exclusion
were excessive frailty (15.3%), severe tricuspid regurgitation (15.3%), and prior aortic valve therapy (14.2%).
Mitral anatomic exclusions were present in 15.8%, with severe annular calcification in 7.4%, and risk for
LVOT obstruction was notably infrequent (4.4%). They showed that those patients ineligible for TMVR and
treated medically have poor outcomes: cardiac death was 11.8% and death or heart failure hospitalization
was 22.4% at one year. These data support the need for development of alternative management with
optimal medical treatment, with the goal of improving the prognosis of these patients.

CONCLUSION
Current percutaneous mitral devices are emerging as a feasible less invasive alternative for patients with
severe MR. The anatomical complexity of MV and the coexistence of various mechanisms of MR might
limit the effectiveness of a unique technique for the treatment of severe MR. Along with the optimal medical
therapy and the appropriate candidate selection by the heart team, the use of combined percutaneous
techniques may be necessary in the future to optimize results and improve long-term outcomes. Upcoming
trials are expected to address knowledge gaps, improving their safety and efficacy. The knowledge of this
constantly evolving technology by clinical and interventional cardiologists might significantly improve
patient outcomes.

DECLARATIONS
Authors’ contributions
Article conception and design: Cepas-Guillen PL, Flores-Umanzor E, Regueiro A, Freixa X
Acquisition and analysis of bibliographic information: Cepas-Guillen PL, Flores-Umanzor E
Drafting of the manuscript: Cepas-Guillen PL, Flores-Umanzor E
Critical revision and final approval of the manuscript: Regueiro A, Freixa X

Availability of data and materials
Not applicable.

Financial support and sponsorship
None.

Conflicts of interest
All authors declared that there are no conflicts of interest.

Ethical approval and consent to participate
Not applicable.

Consent for publication
Not applicable.