Mitral regurgitation in heart failure: time for a rethink

Abstract

Secondary (or functional) mitral regurgitation (MR) frequently accompanies heart failure syndromes and is associated with poor prognosis.1 Initial surgical approaches2 failed to impact on outcome in contrast with optimized medical therapy, cardiac resynchronization therapy (CRT), long-term ventricular assist devices, and cardiac transplantation. Valve surgery remains challenging in this setting, with inferior outcomes than in primary (or degenerative) MR, and the indications and choice of technique are not supported by robust evidence.3 Transcatheter treatment of primary and secondary MR has emerged as an alternative using a variety of approaches. Of these, the most widely adopted has been edge-to-edge repair using the MitraClip device (Abbott Vascular). However, despite application in >70 000 patients since 2003 and favourable evidence compared with surgery in patients with mainly primary MR (73%),4 there have been no published randomized studies focusing on subjects with secondary MR. Until now.