Cerebral Embolic Risk During Transcatheter Mitral Valve Interventions An Unaddressed and Unmet Clinical Need?

Matteo Pagnesi, Damiano Regazzoli, Marco B. Ancona, Antonio Mangieri, Giuseppe Lanzillo, Francesco Giannini, Nicola Buzzatti, Bernard D. Prendergast, Susheel Kodali, Alexandra J. Lansky, Antonio Colombo, Azeem Latib

As new transcatheter mitral valve (MV) interventions continuously evolve, potential procedure-related adverse events demand careful investigation. The risk of cerebral embolic damage is ubiquitous in any left-sided structural heart intervention (and potentially linked to long-term neurocognitive sequelae); therefore, efforts to evaluate these aspects in the field of catheter-based MV procedures are justified. Given the peculiarities of MV anatomy, MV disease, and MV procedures, the lessons learned from other transcatheter heart interventions (i.e., transcatheter aortic valve replacement) cannot be directly translated to MV applications. Through a systematic assessment of available evidence, the authors present and discuss procedure- and patient-related factors potentially associated with cerebral embolic risk during catheter-based MV interventions. Given the paucity of available data in this field, future large, dedicated studies are needed to understand whether cerebral embolic injury represents a real clinical issue during MV procedures.