Mitral Regurgitation Intervention: European Society of Cardiology Statement
- De Bonis M, Al-Attar N, Antunes M, et al.
- Surgical and Interventional Management of Mitral Valve Regurgitation: A Position Statement From the European Society of Cardiology Working Groups on Cardiovascular Surgery and Valvular Heart Disease. Eur Heart J 2015;Jul 7:[Epub ahead of print].
The following are key points to remember from the European Society of Cardiology regarding surgical and interventional management of mitral valve regurgitation:
- Surgical and interventional treatment for mitral regurgitation (MR) require a multidisciplinary approach. Experienced operators in high volume centers with a dedicated Heart Team obtain the best outcomes.
- Surgical mitral valve repair is the reference standard treatment in primary MR. Timely surgery is associated with excellent clinical outcomes, and restoration of normal life expectancy. Percutaneous procedures should be reserved for symptomatic patients who are either at high risk for surgery or inoperable.
- The choice of treatment in secondary MR is more controversial:
- Surgical correction can improve symptoms and quality of life, and can reverse left ventricular (LV) remodeling in selected patients. However, a clear prognostic benefit in comparison with optimal medical therapy has not been demonstrated.
- Undersized annuloplasty might offer a satisfactory result if performed before the onset of severe LV dilatation and in the absence of echocardiographic predictors of postoperative residual or recurrent MR. Otherwise, mitral valve replacement with preservation of the subvalvular apparatus is preferable.
- Percutaneous edge-to-edge repair for secondary MR is a low-risk option to reduce symptoms and promote LV reverse remodeling, but commonly is associated with residual and/or recurrent MR. The procedure should be reserved for patients who have significant symptoms despite optimal heart failure therapy (including cardiac resynchronization therapy where appropriate), are judged by a Heart Team to be at excessive risk for mitral valve surgery, fulfill echocardiographic criteria of eligibility, and do not have existing comorbidities that would obviate any benefits associated with the reduction of MR.
- Ongoing trials in patients with isolated secondary MR will define whether percutaneous edge-to-edge repair has a significant role in the management of heart failure.
- Randomized studies are needed to clarify whether correction of MR in high-risk patients provides clinical and prognostic benefit compared to optimal medical therapy.
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