Transseptal transcatheter mitral valve replacement with dedicated prosthesis: current devices and early results

Transcatheter mitral valve replacement (TMVR) has emerged as a transformative intervention for patients with severe mitral valve disease who are at high or prohibitive surgical risk. Among the various access routes, the transseptal approach has gained prominence due to its minimally invasive nature and favorable hemodynamic profile. The transseptal route offers direct access to the mitral valve while avoiding thoracotomy and cardiopulmonary bypass, making it particularly suitable for frail and comorbid patients. However, it poses unique technical challenges, including precise transseptal puncture, complex valve anchoring in the dynamic mitral annulus, and management of left ventricular outflow tract obstruction risk. Multimodal imaging, especially real-time 3D transesophageal echocardiography and cardiac computed tomography, plays a pivotal role in procedural planning and execution. This review underscores the transseptal TMVR approach as a rapidly advancing frontier in structural heart disease treatment, emphasizing the need for further randomized trials and long-term data to fully define its role in the therapeutic landscape of mitral valve disease.