The following are key points to remember from this JACC state-of-the-art review on current status and future prospects of transcatheter mitral valve replacement (TMVR):

1. Mitral regurgitation (MR) is the most prevalent valvular heart disease and, when left untreated, it confers a poorer prognosis.
2. Several catheter-based therapies have emerged over the past decades targeting this patient population, and particularly the transcatheter edge-to-edge mitral valve repair (TEER) technique is currently supported by a growing body of evidence.
3. Nevertheless, TEER still faces significant drawbacks, such as its limited applicability to all anatomic substrates (e.g., leaflet thickening and calcification, short posterior mitral leaflet with limited motion), as well as its inability to both fully correct the severity of the regurgitation and prevent MR progression over time.
4. TMVR has emerged as a less invasive approach potentially overcoming some of the current limitations associated with the TEER technique.
5. Early clinical experience with transfemoral-transeptal TMVR has been promising and six TMVR systems under clinical investigation permit entirely percutaneous procedures.
6. Current data suggest the superiority of TMVR over TEER regarding valve performance and the presence of residual MR.
7. Patient selection based on clinical history and imaging-guided suitability is a key step before TMVR.
8. Cardiac computed tomography is a prerequisite for anatomic screening, and it allows for optimal annular sizing, calcium assessment, and quantification, as well as risk stratification for specifically procedure-related complications.
9. However, several concerns remain, like the high rate of major bleeding events, the risk for left ventricular outflow tract obstruction, and the relatively high early mortality rates with TMVR.
10. Larger trials with longer follow-up are needed to further evaluate the risks and benefits of TMVR in comparison with other catheter-based and surgical strategies for patients with advanced mitral valve disease.

Clinical Topics: Cardiac Surgery, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Prevention, Valvular Heart Disease, Cardiac Surgery and Arrhythmias, Cardiac Surgery and VHD, Interventions and Imaging, Interventions and Structural Heart Disease, Mitral Regurgitation

Keywords: Cardiac Surgical Procedures, Catheters, Diagnostic Imaging, Heart Valve Diseases, Heart Valve Prosthesis Implantation, Hemorrhage, Mitral Valve Insufficiency, Risk Assessment, Secondary Prevention, Transcatheter Aortic Valve Replacement

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