Lessons learned from Percutaneous Indirect Annuloplasty in the Treatment of Mitral Regurgitation and Future Perspectives

Abstract

Mitral annuloplasty is the most performed surgical procedure in the treatment of mitral valve regurgitation. However, the morbidity and mortality risks associated with this procedure limit its broader application, especially in patients with comorbidities or less severe mitral valve regurgitation. A less invasive percutaneous approach associated with lesser morbidity might offer advantages compared with mitral annuloplasty in some patients. In order to find such an approach, the use of the coronary sinus has been extensively explored. The anatomical relationship between the coronary sinus and the posterior annulus of the mitral valve inspired several creative solutions to restore mitral leaflets coaptation. Coronary sinus annuloplasty attempts to replicate the results of surgical annuloplasty by reducing the antero-posterior diameter of the mitral annulus. In the present manuscript, we performed a systematic review of the devices using the coronary sinus as a key element to correct mitral regurgitation, including two devices still in preclinical phase and those currently awaiting premarket approval. We discussed the most recently published results related to percutaneous annuloplasty, highlighted the pros and cons of each approach, and summarized the lessons learned to improve clinical results.

Key-words: Mitral valve regurgitation; mitral annuloplasty; percutaneous indirect annuloplasty; mitral valve; coronary sinus; valvular heart disease.