Despite a higher log EuroSCORE, high-surgical-risk patients with symptomatic severe MR treated with transcatheter MV repair show similar survival rates compared with surgically treated patients, with both displaying survival benefit compared with conservative treatment.

Sarcoidosis is a systemic disease of an unknown aetiology, in which noncaseating granulomas are formed in one or multiple organs, with pulmonary involvement in >90% of the sarcoidosis patients [1]. Pulmonary hypertension (PH), defined as a mean pulmonary artery pressure of ⩾25 mmHg by right heart catheterisation (RHC) [2], is a well recognised complication of sarcoidosis, associated with significant increase in mortality [3,4]. Although the first case of PH in sarcoidosis was described in 1949 [5], the exact prevalence remains unclear. Only three studies have previously investigated the PH prevalence independently of suggestive symptoms and signs for PH, resulting in prevalence rates of 5.7%, 14% and 20.8% [6][7][8]. In patients with complaints suggestive of PH or those awaiting lung transplant, rates of PH up to 79% have been reported [9][10][11]. Unfortunately, most studies are retrospective and have used an echocardiographic definition for PH (increased right ventricular systolic pressure (RVSP) of ⩾40 mmHg), lacking RHC as gold standard.

Percutaneous MVR using the MitraClip system has favorable long-term survival rates in high surgical risk patients. Preprocedural NYHA functional class III and IV, elevated log-NTproBNP levels and advanced age predict higher long-term cardiac mortality and should be considered during patient selection.

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This matched analysis suggests a lower mortality hazard for MitraClip intervention in a high-risk population with symptomatic mitral regurgitation when compared with conservative management alone.