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Mitral valve interventions in heart failure
Daniel Lavall1, Andreas Hagendorff1, Stephan H Schirmer2
1Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Leipzig, D-04103, Germany.
ESC Heart Failure
|April 21, 2018
Summary
Secondary mitral regurgitation (MR) impacts heart failure patients. Transcatheter repairs and replacements show promise for symptom relief, but long-term survival benefits require further study.
Area of Science:
- Cardiology
- Interventional Cardiology
- Heart Failure Management
Background:
- Secondary mitral regurgitation (MR) stems from left ventricular issues and poses challenges in quantification.
- Severe secondary MR affects up to 25% of heart failure with reduced ejection fraction patients, carrying a high mortality risk.
Purpose of the Study:
- To review current and emerging transcatheter therapies for secondary MR.
- To highlight the need for further research on the long-term impact of these interventions on heart failure prognosis.
Main Methods:
- Review of clinical and echocardiographic evaluations for secondary MR.
- Analysis of emerging transcatheter mitral valve repair (e.g., MitraClip) and replacement devices.
- Discussion of devices targeting annular dilatation (Carillion, Cardioband, Mitralign).
Main Results:
- Transcatheter edge-to-edge repair (MitraClip) can improve symptoms and functional capacity.
- New devices aim to reduce annular dilatation, a key driver of secondary MR.
- Emerging transcatheter mitral valve replacement systems show feasibility in small studies.
Conclusions:
- Current transcatheter and surgical interventions primarily focus on symptom amelioration for severe secondary MR.
- No intervention has definitively improved long-term prognosis in heart failure patients with severe MR.
- Randomized trials comparing interventions to optimized medical treatment are crucial.
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