Percutaneous Edge-to-Edge Mitral Valve Repair for Functional Mitral Regurgitation

Abstract

The presence and severity of functional mitral regurgitation (FMR) is associated with worse outcomes in patients with heart failure and reduced ejection fraction. Prior to the availability of percutaneous mitral valve repair, management for FMR has been limited to medical therapy, cardiac resynchronization therapy for a specific subset of patients and surgery which has yet to demonstrate mortality benefits. Transcatheter edge-to-edge repair (TEER) of the mitral valve has emerged in the past decade as an invaluable member of the armamentarium against FMR with the 2 landmark randomized controlled trials providing deep insights on patient selection. In addition, TEER has spurred the rapid advancement in our understanding of FMR. This article seeks to provide an overview as well as our current understanding on the role of TEER in FMR.

Keywords: Heart failure; Mitral regurgitation.

Figure 1. Timeline for TEER in FMR.

TEER = transcatheter edge-to-edge repair; FMR = functional mitral regurgitation; DMR = degenerative mitral regurgitation; EVEREST = Endovascular Valve Edge-to-Edge Repair Study; CE Mark = Conformité Européene Mark; NHCS = National Heart Centre Singapore; TRAMI = transcatheter mitral valve interventions; FDA = Food and Drug Administration; TCVT = Transcatheter Valve Treatment Sentinel Pilot Registry; MARS = MitraClip Asia-Pacific Registry; COAPT = Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients with Functional Mitral Regurgitation; MITRA-FR = Percutaneous Repair with the MitraClip Device for Severe Functional/Secondary Mitral Regurgitation.

Figure 2. Practical algorithm for symptomatic FMR management.

FMR = functional mitral regurgitation; GDMT = guideline-directed medical therapy; CRT-D = cardiac resynchronization therapy-defibrillator; CABG = coronary artery bypass graft; TEER = transcatheter edge-to-edge repair; COAPT = Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients with Functional Mitral Regurgitation; LVAD = left ventricular assist device.