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Updated: Jan 3, 2026

A Simplified Stepwise Approach to Echo Guidance during Percutaneous Mitral Valve Repair
Published on: October 16, 2021
Treatment of Functional Mitral Regurgitation in Heart Failure
Enrico Fabris1, Antonio De Luca2, Giancarlo Vitrella2
1Cardiovascular Department, University of Trieste, Via Valdoni 7, 34129, Trieste, Italy. enrico.fabris@hotmail.it.
Purpose Of Review:
To analyze the current state of the art of functional mitral regurgitation (FMR) treatment.
Recent Findings:
The first-line treatment of severe FMR consists of guideline medical therapy (GMT) and resynchronization therapy when indicated; the impact of new medical therapies like sacubitril/valsartan needs further assessment. Valvular intervention may be considered in FMR symptomatic patients despite GMT, and can be performed surgically or percutaneously. MitraClip is a safe percutaneous procedure associated with symptoms improvement. Recently, the COAPT trial showed superior outcomes for MitraClip versus GMT contrasting the MITRA-FR trial which showed no benefit of MitraClip compared with GMT. These results should be interpreted as complementary rather than opposite. The COAPT trial provided a "proof of concept" that percutaneous treatment of severe FMR in patients without too advanced left ventricular disease translates into a prognostic benefit. Careful patient selection will play a critical role in defining the clinical niche for successful interventions.
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