Current and future directions of therapeutic options for patients with degenerative MR .

S urgical mitral valve repair (MVR) is the gold standard for treating patients affected by severe degenerative mitral regurgitation (DMR). In patients with functional mitral regurgitation (FMR), poor left ventricular (LV) function and comorbidities make the ideal treatment still a matter of debate. Transcatheter MVR (TMVR) technologies have emerged as an alternative to the conventional surgical approach and were first intended to treat high-risk patients. Nowadays, these technologies are growing and their potential allows them to be adopted as a valuable alternative to surgery in lowand medium-risk patients.1 According to the targeted MV apparatus component, MVR devices for DMR can be classified as leaflet repair, direct/indirect annuloplasty, and chordal repair. This classification includes some overlap.2 Transcatheter chordal implantation using expanded polytetrafluoroethylene (ePTFE) sutures is an appealing technique that is supported by its success in conventional open heart surgery, conforming with the “respect rather than resect” principle in MVR.3 The transcatheter chordal repair panorama includes various technologies. Currently, the NeoChord system (NeoChord, Inc.) is leading the count with approximately 1,000 cases performed at the time of this writing, followed by the Harpoon system (Edwards Lifesciences) with 62 patients treated. Additional new technologies are currently under development, including Mitralis (Mitralix, Ltd.), V-Chordal (Edwards Lifesciences), ChordArt (CoreMedic), Polares (Polares Medical), and MitraPatch (Chawla Heart Technologies, LLC). These technologies are further discussed in the following sections.