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Review
. 2020 Aug;8(15):962.
doi: 10.21037/atm.2020.03.202.

Outcomes with percutaneous mitral repair vs. optimal medical treatment for functional mitral regurgitation: systematic review

Hector Cubero-Gallego  1   2 , Daniel Hernandez-Vaquero  1   2   3 , Pablo Avanzas  1   2   4 , Marcel Almendarez  1   2 , Antonio Adeba  1   2 , Rebeca Lorca  1   2 , Jose Rozado  1   2 , Alain Escalera  1 , Jacobo Silva  1   2 , Cesar Moris  1   2   4 , Isaac Pascual  1   2   3
Affiliations
Review

Outcomes with percutaneous mitral repair vs. optimal medical treatment for functional mitral regurgitation: systematic review

Hector Cubero-Gallego et al. Ann Transl Med. 2020 Aug.

Abstract

Functional mitral regurgitation (MR) could be defined as a ventricular disease where mitral valve is structurally normal, left chambers are enlarged and mitral annulus is dilated with lack of coaptation of leaflets. Transcatheter mitral valve repair technique has broadened the therapeutic range in the treatment of severe MR. The aim of this study was to review outcomes of MitraClip vs. medical treatment for functional MR. We also planned to review the concept of functional MR, assessment of the degree, prognosis and therapy options. This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The Medline through PubMed database was used to search. The present review included manuscripts published between January 2009 and September 2019. Two authors independently screened titles and abstracts of all publications, and performed the selection of studies and data extraction. In the case of disagreements, consensus meetings reached the final decision. Inclusion criteria were: (I) randomized controlled trials and (II) works must compare MitraClip versus optimal medical treatment. Transcatheter mitral valve repair along optimal medical treatment has been compared with optimal medical therapy in two different randomized trials. In the COAPT trial, the MitraClip group showed a significant reduction in mortality and heart failure (HF) hospitalizations. In the MITRA-FR trial, no significant differences were observed between both groups. We reviewed important aspects of functional MR and performed a comprehensive review of both trials comparing them and focusing on their differences.

Keywords: Functional mitral regurgitation; MitraClip; heart failure (HF); transcatheter mitral valve repair.

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/atm.2020.03.202). The series “Structural Heart Disease: The Revolution” was commissioned by the editorial office without any funding or sponsorship. DHV served as the unpaid Guest Editor of the series and serves as an unpaid editorial board member of Annals of Translational Medicine from Aug 2019 to Jul 2021. The authors have no other conflicts of interest to declare.

Figures

Figure 1
Figure 1
Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) chart.
Figure 2
Figure 2
MitraClip™ (Abbott Vascular, Santa Clara, CA, USA). (A) MitraClip NTR on the left, and MitraClip XTR on the right; (B) MitraClip grasping mitral valve leaflets; (C) the clip delivery system. (Adapted with permission from Abbot. Images courtesy of Abbott. ©️ 2019 Abbott. All Rights Reserved).
Figure 3
Figure 3
Clinical case of MitraClip after failure of previous surgical repair with annuloplasty. (A) Severe mitral regurgitation; a mid (P2 towards P1) portion of the posterior mitral leaflet is flail due to ruptured chordae, with a flail gap that measures 6 mm (white arrow); (B) three-dimensional transesophageal echocardiography showed flail posterior leaflet (black arrow); (C) severe mitral regurgitation with a PISA radius of 1.7 cm; (D,E,F) transcatheter mitral valve repair (fluoroscopy); (G,H) after the MitraClip implantation, mitral regurgitation reduced to mild; (I) mitral valve area post-MitraClip of 1.8 cm2.
See this image and copyright information in PMC

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