Transapical mitral valve repair procedures: primetime for microinvasive mitral valve surgery

Mitral valve (MV) regurgitation affects more than four million people in the United States (US) and Europe, with an incidence of 1%–2% of the western population. Its prevalence increases with age, affecting up to 10% of the population above 75 years.1 According to current American and European guidelines, surgery is the gold standard therapy to treat mitral regurgitation (MR) in symptomatic patients, supporting surgical repair over replacement with extracorporeal circulation whenever possible.2 Despite MR represents the most frequent valvular heart disease requiring surgery in the United States and the second most common in Europe,3 up to onethird of patients with severe MR are never referred and nearly half are denied for surgery because of prohibitive risk due to age and comorbidities.4 Moreover, by 2030, the increase of the population age will translate in an estimated increase of 50% in heart failure prevalence, resulting in a significantly higher rate of MR, especially due to functional mechanisms.5 Therefore, new less‐invasive therapies are needed to further expand the slice of population to be treated.