Abstract
Mitral regurgitation (MR) is the most common left-sided heart valve disease in developed countries with a constantly rising number of patients requiring hospitalization or intervention. Organic MR is defined as a primary structural abnormality of the mitral valve (MV) apparatus which may be caused by a broad set of pathological processes, among which myxomatous degeneration of the leaflets causing MV prolapse is the most common. If left untreated, chronic severe MR leads to serious adverse outcomes, from heart failure to death, but medical therapy is unable to change the natural history of the disease. Surgical correction, by means of valve repair or replacement, is the gold standard for the treatment of symptomatic patients with severe primary MR. However, surgery is not feasible for a large percentage of patients because of old age, reduced left ventricular ejection fraction and the presence of severe comorbidities. Therefore, in recent years, several percutaneous therapeutic alternatives suitable for high or prohibitive surgical risk patients were developed. In this review we discuss the transcatheter treatment of primary MR, from available evidence to technical practice, with a focus on the percutaneous “edge-to-edge” leaflet repair performed with the MitraClip System and the PASCAL Repair System.
Highlights
Mitral regurgitation (MR) is the most common left-sided heart valve disease in developed countries with a prevalence that increases with age, which in the last decades has led a to a sharp rise in the number of patients requiring hospitalization or intervention[1]
Organic MR is defined as a primary structural abnormality of the mitral valve (MV) apparatus
In a degenerative mitral regurgitation (DMR) setting: the independent catheters should simplify the navigation in the left atrium and the orientation of the device; the larger size of the implant should achieve effective MR reduction; and the wide paddles and optional independent leaflet grasping should ensure reaching a straight leaflet insertion in case of challenging anatomies, with no determinant impact on post-procedural MV gradient
Summary
Mitral regurgitation (MR) is the most common left-sided heart valve disease in developed countries with a prevalence that increases with age As a matter of fact, current guidelines recommend a percutaneous edge-to-edge repair for the treatment of patients with symptomatic moderate-to-severe or severe primary MR who fulfill echocardiographic criteria of eligibility and are judged inoperable or at high surgical risk by the Heart Team evaluation (Class IIb, LOE C)[2].
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