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Updated: May 9, 2026
08:31
A Simplified Stepwise Approach to Echo Guidance during Percutaneous Mitral Valve Repair
Published on: October 16, 2021
When to prefer MitraClip over cardiac surgery
Fausto Castriota1, Angelo Squeri1, Roberto Nerla1
1GVM Care & Research, Maria Cecilia Hospital, Cotignola (RA), Italy.
Summary
Transcatheter edge-to-edge repair (TEER) offers a safe and effective alternative to surgery for severe mitral regurgitation, particularly in high-risk patients. TEER improves quality of life and reduces hospitalizations, challenging the surgical gold standard.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Heart Valve Disease
Background:
- Severe mitral regurgitation (MR) significantly impacts prognosis, leading to high mortality and reduced quality of life.
- Surgical mitral repair is the standard for low-risk patients but is limited in elderly or frail individuals due to perioperative risks.
Purpose of the Study:
- To review the evolving role and evidence supporting transcatheter edge-to-edge repair (TEER) for severe MR.
- To compare TEER with surgical repair in various patient populations and risk profiles.
Main Methods:
- Review of current guidelines, including the 2025 ESC/EACTS recommendations.
- Analysis of key randomized trials (COAPT, RESHAPE-HF2, MATTERHORN) and ongoing studies (REPAIR-MR, MITRA-HR).
Main Results:
- TEER, primarily using MitraClip™, is recommended for symptomatic severe secondary MR despite optimal therapy.
- Studies show TEER is non-inferior to surgery in efficacy with a better safety profile, reducing hospitalizations and improving quality of life.
- Ongoing trials investigate TEER versus surgery for primary MR in moderate-to-high surgical risk patients.
Conclusions:
- MitraClip™ is the preferred treatment for high-risk secondary MR.
- Surgery remains the standard for repairable primary MR in low-risk surgical candidates.
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