The role of transcatheter mitral valve leaflet approximation for the treatment of secondary mitral regurgitation: current status and future prospects

ABSTRACT

Introduction: Secondary mitral regurgitation (SMR) is one of the most common valvulopathies and is associated with poor prognosis. Over the past years, medical management and mitral valve repair options have rapidly evolved offering new opportunities for a wide range of patients.

Areas covered: We provide an up-to-date review of the value of medical and transcatheter mitral valve leaflet approximation for SMR integrating the results of most recent trials and putting their findings into clinical perspective.

Expert opinion: Treatment of SMR requires a multidisciplinary approach with a long-term perspective. After optimization of medical treatment, transcatheter mitral valve repair should be considered in patients with persisting symptomatic severe SMR to improve symptoms and prognosis.

KEYWORDS:

• Heart failure
• secondary mitral regurgitation
• transcatheter mitral valve repair
• edge-to-edge repair
• valvular heart disease
• MitraClip
• MITRA-FR
• COAPT; PASCAL; leaflet approximation

Article highlights

• Relevant secondary mitral valve regurgitation is a frequent entity in heart failure patients with reduced left ventricular ejection fraction.

• A multidisciplinary evaluation by an extended Heart Team is needed to ensure optimal evidence-based care.

• The cornerstone of treatment is the initiation and optimization of guideline-directed medical therapy.

• Mitral valve surgery is indicated in operable patients requiring coronary revascularisation.

Transcatheter leaflet approximation is safe and should be evaluated in symptomatic patients with persisting severe secondary mitral regurgitation despite guideline-directed medical therapy, in particular those fulfilling the COAPT inclusion criteria.

Declaration of interest

F Praz has received travel expenses from Abbott Vascular, Edwards Lifesciences, and Polares Medical. S Windecker has received research and educational grants to the institution from Abbott, Amgen, Bristol Myers Squibb, Bayer, Boston Scientific, Biotronik, Cardinal Health, Cardiovalve, CSL Behring, Daiichi Sankyo, Edwards Lifesciences, Johnson & Johnson, Medtronic, Querbet, Polares, Sanofi, Terumo, and Sinomed; has served as an unpaid member of the steering/executive group of trials funded by Abbott, Abiomed, Amgen, Bristol Myers Squibb, Boston Scientific, Biotronik, Cardiovalve, Edwards Lifesciences, MedAlliance, Medtronic, Polares, Sinomed, V-Wave and Xeltis for which he received no personal payments by any pharmaceutical company or device manufacturer; and has been a member of the steering/executive committee group of several investigated-initiated trials that receive funding by industry without impact on his personal remuneration. A Vahanian has received consultancy fees for CardioValve. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer Disclosures

One peer reviewer has received research grants from Abbott Vascular and Edwards Lifesciences. One peer reviewer has received speaker honoraria and travel compensations from: Abbott Medical, AstraZeneca, Abiomed, Bayer vital, BIOTRONIK, Bristol–Myers Squibb, CytoSorbents, Daiichi Sankyo Deutschland, Edwards Lifesciences Services, Sedana Medical, München Klinik gGmbH, Münchner Akademie für ärztliche Fortbildung, Notfallakademie GmbH; and has 3rd party stock ownership via Bayerische Ärzteversorgung, Bayerische Versorgungskammer, Alte Leipziger, Heidelberger Leben, Skandia, MomoGbr etc: e.g. Abbott Laboratories, AstraZeneca, Bayer, Biontech, Bristol-Meyer-Squibb, Curevac, Draegerwerk, Fresenius Medical Care, Gilead sciences, Johnson&Johnson, Linde, Merck US, Moderna, NovoNordisk, Nuance Communications, Pfizer, Proctor&Gamble, Roche, SAP, Siemens healthiniers, Zoom etc. Peer reviewers on this manuscript have no other relevant financial relationships or otherwise to disclose.

Additional information

Funding

This paper was not funded.