ACE Technology Guidances communicate recommendations from the MOH Drug Advisory Committee or the MOH Medical Technology Advisory Committee on the funding status and appropriate use of drugs, vaccines or medical technologies that have been evaluated by ACE. The guidances also include the Committee’s rationale for the funding recommendations, and key clinical and economic evidence which informed their deliberations. Plain English Summaries (PES) to explain ACE Technology Guidances are available for patients and the public.

Published on 30 Jun 2021
Last Updated on 30 Jun 2021
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Guidance Recommendation

The Ministry of Health’s Medical Technology Advisory Committee has recommended subsidy for transcatheter mitral valve leaflet repair (TMVLR) for:

  • Adults aged 18 years and older with symptomatic (New York Heart Association (NYHA) class II and above) grade 3+ (moderate-to-severe) or 4+ (severe) mitral regurgitation, if they meet all the following criteria as assessed by a multidisciplinary team:
    • Patient has been treated with maximally tolerated guideline-directed medical therapy or revascularisation, where appropriate, for mitral regurgitation, heart failure, left ventricular dysfunction, and coronary artery disease; and
    • Patient is ineligible for surgical intervention; and
    • Patient is anatomically suitable for TMVLR.
  • Patients with secondary mitral regurgitation, only if the patients do not have significant left ventricular dilatation or dysfunction, as per the inclusion criteria for the COAPT trial. For example, patients should have left ventricular ejection fraction greater or equal to 20% but less than or equal to 50%, and left ventricular end systolic dimension less than or equal to 70 mm.

TMVLR should be performed via transfemoral delivery, unless contraindicated.

The Committee has recommended that TMVLR operators must have undergone didactic and practical training on implanting the TMVLR device prior to being allowed to independently carry out the procedure. These training sessions must be documented and surfaced for periodic audits along with documented approval from the Head of the Valve Programme at centres approved to offer the TMVLR service.

Subsidy status

Subsidy for TMVLR for the abovementioned criteria is applicable only for treatments performed in centres approved to offer the TMVLR service by operators that have undergone didactic and practical training on the TMVLR device.

Centres offering the TMVLR service must provide relevant data to the Ministry of Health on an ongoing basis, for outcome evaluation purposes.

Transcatheter mitral valve leaflet repair for patients with mitral regurgitation