Contemporary Transcatheter Approaches to Mitral Regurgitation

Mitral regurgitation (MR) is a prevalent and prognostically relevant valvular disease, especially in patients with heart failure, in whom MR contributes to adverse remodeling, increased symptom burden, and higher mortality. Surgical repair or replacement remains the standard of care for suitable candidates, but many patients are excluded because of advanced age, comorbidities, or high surgical risk. Transcatheter methods have emerged as transformative alternatives, including mitral transcatheter edge-to-edge repair (MTEER) with devices such as MitraClip and PASCAL, annuloplasty-based devices such as Carillon and Cardioband, and transcatheter mitral valve replacement (TMVR) with devices such as Tendyne, Intrepid, and others under development. Data from randomized trials and registries have established that MTEER lowers hospital readmission rates and improves mortality in carefully selected secondary MR subjects, and that device upgrades improve procedural success and anatomical versatility. Annuloplasty provides targeted repair for functional MR with annular dilation, whereas TMVR offers an alternative for anatomically complex cases or those ineligible for MTEER, albeit with distinct procedural risks. Management of severe mitral annular calcification remains difficult and demands meticulous pre-procedural planning and customized device strategies. Careful patient selection based on MR etiology, proportionality, ventricular function, and anatomical suitability is essential for optimizing outcomes in this rapidly evolving field.