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REVIEW article

Front. Cardiovasc. Med.
Sec. Heart Surgery
Volume 10 - 2023 | doi: 10.3389/fcvm.2023.1101337


 Riccardo Cocchieri1*, Bertus van de Wetering2, Jan Baan Jr3, Antoine Driessen4, Robert Riezebos5, Sjoerd van Tuijl2 and  Bastianus De Mol1, 2, 4
  • 1Onze Lieve Vrouwe Gasthuis (OLVG), Netherlands
  • 2LifeTec Group (Netherlands), Netherlands
  • 3Amsterdam University Medical Center, Cardiology,, Netherlands
  • 4Amsterdam University Medical Center, Netherlands
  • 5OLVG Hospital, Cardiology, Netherlands

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This report describes how the evolution of transcutaneous mitral valve intervention (TMVI ) is influenced by lessons learned from three evolutionary tracks: 1. the development of state of the art treatment from mitral valve surgery (MVS) to transcutaneous procedures; 2. the evolution of biomedical engineering for research and development resulting in predictable and safe clinical use; 3. the adaptation to local conditions, impact of transcutaneous aortic valve replacement (TAVR) experience and creation of infrastructure for skills development and risk management.
Abundant literature regarding MVS experience shapes the indication area and treatment expectations for TMVI, including transcutaneous edge-to-edge repair (TEER) and transcutaneous mitral valve replacement (TMVR). The expected performance of TMVI should be measured by standards of risk-benefit considerations and actual outcomes set by minimally invasive mitral valve surgery (MIMVS). At the institutional level, heart teams can make decisions based on the best knowledge acquired from surgical experience in mitral valve disease.
The evolution of TMVI evidently meets challenges due to the complexity of the mitral valve apparatus and is still limited to high-risk surgical cases. Indications and risk-benefits are still in development depending on the complexity of the device, including TMVR. Biomedical engineers describe the Research and Development cycle for TMVI, including the relevance of human factor engineering. In the R&D phase estimations of the strengths and limitations of clinical use should be made, including the level of skills and associated necessary training. This can be done by a Physicians Preference Test or use of a biosimulator.
Supported by clinical data from two heart centers in Amsterdam, we additionally describe the evolution of a professional ecosystem for applying innovation. Adaptation to local conditions in terms of infrastructure, referrals and reimbursement appears essential for the evolution of a complete mitral valve disease management program. Efficacy of institutional risk management performance (IRMP) and sufficient team skills should be embedded in an appropriate infrastructure, which enables scale and offers complete and safe solutions for mitral valve disease. The longstanding evolution of mitral valve therapies is the result of working devices embedded in an ecosystem focused on developing skills and effective risk management actions.

Keywords: mitral, Minimally, invasive, percutaneous, risk, Reduction, TMVR, MIMVS

Received: 17 Nov 2022; Accepted: 29 Mar 2023.

Copyright: © 2023 Cocchieri, van de Wetering, Baan Jr, Driessen, Riezebos, van Tuijl and De Mol. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Mx. Riccardo Cocchieri, Onze Lieve Vrouwe Gasthuis (OLVG), Amsterdam, Netherlands