The success of transcatheter aortic valve replacement has generated optimism that the much larger pool of mitral regurgitation patients can be similarly served. While big strategics bet on replacement, however, other companies are betting on repair, developing less invasive devices inspired by an array of established mitral valve surgical repair techniques.

Amid the success of transcatheter aortic valve replacement (TAVR), strategic acquisitions of transcatheter mitral valve replacement (TMVR) companies and the success of mitral valve repair device MitraClip, a group of companies are developing a number of minimally invasive options to repair mitral valves. Whether minimally invasive repair, replacement, or some combination will emerge as the best option for patients with mitral regurgitation remains unclear, and insiders say this road will be rockier than it was for TAVR.

After more than a decade, the field of transcatheter mitral valve therapy is still in its infancy, yet it is surprisingly crowded. The first percutaneous mitral valve company was founded in 1999, the same year that the first transcatheter aortic valve implantation (TAVI) company was founded, but while TAVI is now on the market in Europe and in the US, the leading transcatheter mitral valve therapy has only just completed clinical trials.

While there is no question that heart valve repair and replacement is moving toward minimally invasive techniques and devices, there is a big difference between a minimally invasive surgical approach and a truly percutaneous, incisionless procedure. The challenges of reaching the latter goal are substantial, but apparently not insurmountable., In fact, recent progress in this field provides hope that in the not too distant future, percutaneous valve replacement and repair will become an accepted part of the treatment armamentarium, greatly expanding the number of patients who can be offered these potentially life-saving procedures.