{"id":8322,"date":"2025-08-16T00:37:33","date_gmt":"2025-08-15T21:37:33","guid":{"rendered":"https:\/\/jordan-cardiac.org\/?p=8322"},"modified":"2025-08-16T00:37:33","modified_gmt":"2025-08-15T21:37:33","slug":"intravascular-lithotripsy-ivl-for-mitral-valve-disease-summary","status":"publish","type":"post","link":"https:\/\/jordan-cardiac.org\/en\/intravascular-lithotripsy-ivl-for-mitral-valve-disease-summary\/","title":{"rendered":"Intravascular Lithotripsy (IVL) for Mitral Valve Disease \u2013 Summary"},"content":{"rendered":"
Intravascular Lithotripsy (IVL) for Mitral Valve Disease \u2013 Summary<\/div>\n
<\/div>\n
Published: August 13, 2025 | Medical News Highlights \u2013 Structural Interventions Section<\/div>\n
<\/div>\n
Context on Valve Regurgitation Treatments<\/div>\n
<\/div>\n
In transcatheter valve therapy, approaches differ by valve type:<\/div>\n
* Aortic Valve (AV): Treated with TAVR, which fully replaces the valve.<\/div>\n
* Mitral Valve (MV): Commonly treated with TEER (Transcatheter Edge-to-Edge Repair), using devices like MitraClip to reduce regurgitation by approximating leaflets.<\/div>\n
* Tricuspid Valve (TV): Most often treated with TEER using devices like TriClip. Transcatheter tricuspid valve replacement (TTVR) is technically feasible but remains experimental, reserved for selected cases in advanced centers only.<\/div>\n
* TMVR: A full catheter-based replacement of the mitral valve\u2014currently limited to clinical trials and select patients, especially when severe Mitral Annular Calcification (MAC) poses technical challenges.<\/div>\n
<\/div>\n
1. Background<\/div>\n
\u2022 IVL has shown effectiveness in fracturing thin arterial calcium during revascularization.<\/span><\/div>\n
\u2022 Researchers explored its potential to break dense calcification in MAC\u2014a significant barrier to structural heart interventions.<\/span><\/div>\n
\u2022 This concept saw a real-world application in a JSCAI\u2013published case (within the APOLLO trial), where IVL was used in a patient with severe MAC undergoing TMVR using Medtronic\u2019s Intrepid valve.<\/span><\/div>\n
\u2022 The Intrepid valve is a self-expanding transcatheter mitral replacement system developed by Medtronic, designed to fully replace diseased mitral valves without open-heart surgery.<\/span><\/div>\n
\u2022 A cerebral protection device was also used during the procedure to reduce the risk of calcium emboli causing stroke\u2014highlighting safety considerations in complex cases.<\/span><\/div>\n
<\/div>\n
2. Study<\/div>\n
\u2022 A cadaver experiment used multiple Shockwave Medical IVL balloons in a heavily calcified mitral annulus.<\/span><\/div>\n
\u2022 Delivered 600 low-pressure pulses to avoid damage.<\/span><\/div>\n
\u2022 Imaging revealed some calcium fracture lines, but the impact was too minimal for practical clinical value.<\/span><\/div>\n
<\/div>\n
3. Challenges<\/div>\n
\u2022 Arterial calcium is thin (~eggshell), whereas valve calcium can be centimeters thick.<\/span><\/div>\n
\u2022 Existing IVL balloons (up to 7 mm) are significantly smaller than the mitral orifice (30\u201335 mm).<\/span><\/div>\n
\u2022 Standard balloon valvuloplasty may cause leaflet tearing and severe regurgitation.<\/span><\/div>\n
\u2022 Both TMVR and TEER have limited applicability in cases with heavy calcification.<\/span><\/div>\n
<\/div>\n
4. Next Steps<\/div>\n
\u2022 Innovate larger, high-energy balloons with integrated perfusion to allow longer treatment without blocking blood flow.<\/span><\/div>\n
\u2022 IVL has potential as a preparatory tool for TMVR or to soften MV leaflets for TEER.<\/span><\/div>\n
<\/div>\n
5. Conclusion and Clinical Context<\/div>\n
\u2022 The proof-of-concept shows IVL can fracture thick valve calcium, but current devices are inadequate for clinical use\u2014further technological advances are required.<\/span><\/div>\n
\u2022 APOLLO trial context: Early data show TMVR with Medtronic\u2019s Intrepid valve can be performed successfully in highly selected patients, achieving substantial MR reduction and improved symptoms. However, these were trial-based findings\u2014routine TMVR is not yet endorsed in clinical practice. It remains reserved for clinical trials, compassionate use, and specialized centers, as the technology remains under development.<\/span><\/div>\n
<\/div>\n
Why APOLLO is highlighted: It\u2019s a rare real-world application connecting bench research on IVL with clinical structural intervention\u2014showing how IVL may facilitate TMVR in severe MAC and bridge experimental methods to future patient treatments.<\/div>\n
<\/div>\n
https:\/\/www.cms.gov\/medicare-coverage-database\/details\/nca-decision-memo.aspx?NCAId=297&bc=AAgAAAAACAAA&<\/a><\/div>\n
<\/div>\n
https:\/\/pubmed.ncbi.nlm.nih.gov\/37240685\/?utm_source=chatgpt.com<\/a><\/div>\n
<\/div>\n
https:\/\/www.nejm.org\/doi\/full\/10.1056\/NEJMoa2300213?utm_source=chatgpt.com<\/a><\/div>\n","protected":false},"excerpt":{"rendered":"

Intravascular Lithotripsy (IVL) for Mitral Valve Disease \u2013 Summary Published: August 13, 2025 | Medical News Highlights \u2013 Structural Interventions Section Context on Valve Regurgitation Treatments In transcatheter valve therapy, approaches differ by valve type: * Aortic Valve (AV): Treated with TAVR, which fully replaces the valve. * Mitral Valve (MV): Commonly treated with TEER […]<\/p>\n","protected":false},"author":145,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[],"class_list":["post-8322","post","type-post","status-publish","format-standard","hentry","category-uncategorized"],"_links":{"self":[{"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/posts\/8322","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/users\/145"}],"replies":[{"embeddable":true,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/comments?post=8322"}],"version-history":[{"count":1,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/posts\/8322\/revisions"}],"predecessor-version":[{"id":8323,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/posts\/8322\/revisions\/8323"}],"wp:attachment":[{"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/media?parent=8322"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/categories?post=8322"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/tags?post=8322"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}