Percutaneous and surgical treatment of mitral valve regurgitation

Mitral valve regurgitation is the second most common clinically relevant valvular heart disease in adults, with an incidence of about 2% to 3% per year. Surgical mitral valve repair is the treatment of choice. Recent years have seen major advances in minimally invasive mitral valve surgery. Several new catheter-based techniques are now being clinically evaluated, including percutaneous endovascular mitral valve repair with a mitral clip.

This review is based on a selective review of the literature and on the authors' clinical experience.

Minimally invasive and reconstructive techniques for mitral valve surgery have come into more common use in recent years. In Germany, more than 50% of all mitral valve defects are now treated with a valve-preserving repair procedure. At the same time, percutaneous techniques have been developed that enable reduction of mitral regurgitation in the cardiac catheterization laboratory, without surgery. The implantation of a mitral clip is the sole currently approved technique of this type. In a recently published, randomized comparative clinical trial (EVEREST II), it was found to be safer, but less effective, than surgery.

Mitral valve surgery remains the treatment of choice for severe mitral regurgitation. For patients at high risk from surgery, and particularly those with severe heart failure, the implantation of a mitral clip is a safe and feasible treatment option.