After aortic valve stenosis, mitral regurgitation (MR) is the second most common valvular disease, particulary affecting older patients. Optimal medical treatment within the context of heart failure therapy is the favored first-line therapy for secondary MR. If symptoms persist despite optimal medical therapy, surgical or transcatheter mitral valve repair is indicated (recommendation class IIb). In contrast, surgical treatment is essential for patients with symptomatic primary MR and left-ventricular ejection fraction (LVEF) >30% and justifiable perioperative risk (repair preferred over replacement, recommendation class I); for high-risk patients, interventional transcatheter mitral valve repair (especially by "edge-to-edge-reconstruction") is a viable option (recommendation class IIb).Recently, transcatheter mitral valve replacement (TMVR) has come into focus as another attractive treatment option and is currently under intensive research. At first, the TMVR was used both for patients with symptomatic insufficiency or stenosis after biological mitral valve replacement (Bio-MKE) or after reconstruction as a "valve-in-valve" or "valve-in-ring" procedure. Therefore, transcatheter aortic valve prostheses were used.In the past few years several dedicated TMVR prostheses were developed for the treatment of native MR. So far, no TMVR prosthesis is CE-certified. All of the following TMVR methods are under clinical evaluation in the scope of pivotal trials. The interdisciplinary heart team, consisting of experienced cardiologists and heart surgeons develops a patient-specific, individual treatment concept considering the particular MR etiology, pre-existing comorbidities, age, clinical symptoms, and status.
Keywords: Heart failure; Heart valve diseases; Heart-Team; Mitral valve insufficiency; Transcatheter mitral valve replacement.