Disproportionate functional mitral regurgitation predicts a favourable response after MitraClip implant in patients with advanced heart failure. Real-world evidence of a new conceptual framework.

Frea, Simone; Pidello, Stefano; Boretto, Paolo; Rettegno, Sara; Giordana, Francesca; Montefusco, Antonio; D’Amico, Maurizio; Torre, Michele W La; Rinaldi, Mauro; Ferrari, Gaetano Maria De

doi:10.1016/j.ijcard.2020.08.026

Cited by 3 publications

(1 citation statement)

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“…This new hypothesis is however questioned, Lindenfeld et al [50], define 6 subgroups of the COAPT patients by EROA cutoffs and analysis show that TEER had no benefit on the composite rate of ACM or HFH at 24 months, using the new framework to explain results of MITRA-FR and COAPT trials. Other studies suggest that regurgitant volume-LVEDV association or regurgitant fraction and right ventricular dysfunction assessed by TAPSE (Tricuspid Annular Plane Systolic Excursion) may be considered more predictive of outcome than the EROA-LVEDV association and may help the selection of patients to TEER [54,55].…”

Section: The Third "Wheel": Transcatheter Edge-to-edge Repairmentioning

confidence: 99%

Learning from Controversy and Revisiting the Randomized Trials of Secondary Mitral Regurgitation

Fiore

Singh

Nappi

2022

Rev. Cardiovasc. Med.

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Until recently, conventional mitral valve surgery has been the treatment of choice even in secondary mitral regurgitation. Recent evidence, however, advocates the use of transcatheter edge-to-edge mitral valve repair (TEER) of the mitral valve. This has been reflected by the change in guidelines of the American College of Cardiology/American Heart Association. We reviewed the literature to shed light on the risks and benefits of all interventions, surgical, transcatheter and guideline-directed medical therapy. Secondary mitral regurgitation occurs due to an imbalance between closing forces and tethering forces. Given the pathology extends beyond the valve alone, treatment should be directed at restoring the geometrical shape of the left ventricle alongside the valve. Myocardial revascularization plays a pivotal role in preventing recurrence. The role of papillary muscle approximation in addition to restrictive mitral annuloplasty should be considered in a select group of patients. We also reviewed the current literature on TEERs from the COAPT and Mitra-FR trials while highlighting the concept of proportionate/disproportionate MR which may help identify which patients benefit from mitral valve restoration. Treatment of this condition will require robust randomized trials alongside the use of state-of-the-art imaging technologies available with the full complement of the multidisciplinary team to ensure the best outcomes for each patient.

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Section: The Third "Wheel": Transcatheter Edge-to-edge Repairmentioning

confidence: 99%