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Agency for Care Effectiveness
Cardiovascular

Transcatheter mitral valve leaflet repair (TMVLR) for patients with mitral regurgitation

29 September 2023

Published on 30 Jun 2021
Last Updated on 29 Sep 2023

Guidance Recommendation

The Ministry of Health’s Medical Technology Advisory Committee has recommended transcatheter mitral valve leaflet repair (TMVLR) for mitral regurgitation in line with the following criteria:   

  • 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 who do not have significant left ventricular dilatation or dysfunction, as per the inclusion criteria for the COAPT trial (e.g. 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.

  • TMVLR operators must have 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. 

Funding status

TMVLR is recommended for inclusion on the MOH Medical Technology Subsidy List (MTSL). Listed models are recommended for subsidy when used in line with the abovementioned recommendations.

Transcatheter mitral valve leaflet repair for patients with mitral regurgitation [PDF, 183 KB]

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