Percutaneous mitral edge-to-edge repair

Abstract

Functional mitral regurgitation, now better known as secondary mitral regurgitation, is the most common acquired heart disease in the world. In most cases, patients with secondary mitral regurgitation have a rather poor prognosis, for example, about 50% of patients are at high risk of surgery or are inoperable, while mortality within 1 year without surgery is 57%. The tactics of treating these patients is the subject of much debate. According to the American Association for Thoracic Surgery (Ischemic Mitral Regurgitation Consensus Guidelines Writing Committee), mitral valve reconstruction is accompanied by a large number of relapses of mitral insufficiency in the long term after surgery, and mitral valve replacement is characterized by high mortality (≥ 13%). With the optimal selected conservative therapy (Guideline-directed medical therapy), in most patients, there is no significant improvement in their condition. Since the 2000s the development of methods of interventional influence on the mitral valve for the treatment of such patients is underway. In the 2010s, interventional treatment techniques began to be widely used, and recommendations for their use began to be developed. In some cases, the results of using the techniques are superior to open surgery. Is it possible to say that the problem of treating patients with functional mitral insufficiency of high operative risk has been solved? In order to answer this question, a literature review was carried out on the interventional treatment of secondary mitral regurgitation using the "edge-to-edge" technique.We used PICO strategy (Patient, Intervention, Comparison, Outcome) for searching articles. A systematic search for information on the research topic was carried out in the PubMed and Google Scholar databases using search queries, keywords, and logical operators AND, OR. Key words: mitral regurgitation, functional mitral regurgitation, chronic mitral regurgitation, MitraClip, percutaneous mitral repair, mitral insufficiency, mitral valve, Edge-to-Edge repair. In the initial selection, 1,180 publications were received. After analyzing the titles and abstracts, 94 articles were selected, and full-text copies were studied. The final analysis included 43 articles and 2 randomized clinical trials. We have compiled a literature review on the interventional treatment of secondary mitral regurgitation using the "edge-to-edge" technique.Received 13 July 2021. Revised 4 August 2021. Accepted 9 August 2021.Funding: The study did not have sponsorship.Conflict of interest: Authors declare no conflict of interest.Contribution of the authors: The authors contributed equally to this article.