ACC Releases Updated Guidance For the Management of Mitral Regurgitation

The ACC released the 2020 Focused Update of the 2017 Expert Consensus Decision Pathway on the Management of Mitral Regurgitation Feb. 14 in the Journal of the American College of Cardiology. The document emphasizes that recognition of mitral regurgitation (MR) should prompt an assessment of its etiology, mechanism, and severity, as well as consideration of the indications for treatment.

Cardiology Magazine ImageRobert O. Bonow, MD, MACC
Cardiology Magazine ImagePatrick T. O'Gara, MD, MACC

Led by Writing Committee Chair Robert O. Bonow, MD, MACC, and Vice Chair Patrick T. O'Gara, MD, MACC, the document updates sections in the 2017 Expert Consensus Decision Pathway, and adds sections in light of newly published trial data related to secondary MR – including the MITRA-FR and COAPT trials – among other developments. The recommendations are based on the 2014 American Heart Association (AHA)/ACC Guideline for the Management of Patients with Valvular Heart Disease and its 2017 focused update.

Of note, the document provides expert consensus on clinical and echocardiographic assessment; establishment of MR etiology (primary, secondary, mixed) and mechanism; consideration of associated hemodynamic consequences; recognition of the indications for surgical or transcatheter intervention; appreciation of the increasing complexity of surgical mitral valve repair as a function of pathoanatomy; and understanding of the current role for transcatheter mitral valve edge-to-edge repair using a clip device.

The writing committee also emphasizes a structured approach to evaluation based on clinical findings, accurate echocardiographic imaging, and, when necessary, adjunctive testing, "[which] can help clarify decision-making."

Bonow and O'Gara further explain that "a highly functional, integrated multi-disciplinary heart team is an essential requirement for institutions offering transcatheter mitral valve interventions." They add that all treatment options for MR – medical, CRT, transcatheter, surgical – should be considered by the multi-disciplinary heart team. In addition, "shared decision-making accounting for patient values and preferences is an essential component of the management algorithm."

They conclude that moving forward, "introduction of novel transcatheter MV repair and replacement systems into clinical practice is anticipated in future years."

The College has a number of tools for both clinicians and patients to improve valvular care through appropriate diagnosis, referral and treatment. For clinicians, the ManageMR Toolkit guides clinicians from assessment to referral of diagnosed MR patients. The ManageMR App offers clinicians personalized referral and treatment advice for diagnosed MR patients by verifying the severity and etiology of the MR. For patients, CardioSmart's Heart Valve Disease Hub provides information and tools to better understand heart valve disease, MR, aortic stenosis and more. The Mitral Regurgitation Patient Tool helps patients understand what they need to do upon being diagnosed with MR.

Also join the ACC in recognizing National Heart Valve Disease Awareness Day on Feb. 22 as part of American Heart Month. The ACC will be participating in a Twitter Chat with the Alliance for Aging Research on Feb. 19. Join the conversations by using #ValveDiseaseDay and tagging @ACCinTouch.

Clinical Topics: Cardiac Surgery, Cardiovascular Care Team, Noninvasive Imaging, Valvular Heart Disease, Cardiac Surgery and VHD, Echocardiography/Ultrasound, Mitral Regurgitation

Keywords: Mitral Valve Insufficiency, Mitral Valve, American Heart Association, Consensus, Echocardiography, Heart Valve Diseases, Hemodynamics, Surgical Instruments

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