Abstract
Advanced heart failure (HF) prevalence is increasing and ranges between 1% and 10% of the overall HF population, due to the growing number of patients with HF and their better treatment and survival in the last 20 years. The best treatment for these patients is represented by heart transplantation, which, unfortunately, is only available for a minority of them. A significant portion of patients with advanced HF has concomitant severe mitral regurgitation, which acts as a driving force in inducing and maintaining this end-stage condition in a vicious cycle. Percutaneous mitral valve repair with MitraClip is a treatment option to stop this vicious cycle, providing safer outcomes and clinical benefits in some of these patients. Preliminary clinical observations show a possible selective role for percutaneous mitral valve treatment with MitraClip as a bridge to transplantation, candidacy or recovery. Further evidence will be necessary to confirm these preliminary data and support this new treatment framework of patients with advanced HF.
Highlights
Mitral regurgitation (MR) is the most common valve disease worldwide, affecting at least 20% of patients aged > 65 years[1]
While the ischemic vs. non-ischemic etiologies do not impact on these findings[3], higher grades of Secondary MR (SMR) severity are associated with reduced www.misjournal.net
Severe cardiac dysfunction (LVEF ≤ 30%), isolated RV failure (e.g., ARVC) or non-operable severe valve abnormalities or congenital abnormalities or persistently high BNP or NT-proBNP values and severe diastolic dysfunction or left ventricle (LV) structural abnormalities according to HF with preserved ejection fraction (HFpEF) and HFmrEF ESC definitions 3
Summary
Mitral regurgitation (MR) is the most common valve disease worldwide, affecting at least 20% of patients aged > 65 years[1]. Secondary MR (SMR) is the predominant and most clinically relevant form. SMR, even when mild, correlates with higher adverse outcomes[2]. While the ischemic vs non-ischemic etiologies do not impact on these findings[3], higher grades of SMR severity are associated with reduced www.misjournal.net. 2018 HFA-ESC criteria for defining advanced heart failure. Severe and persistent symptoms of heart failure [NYHA class III (advanced) or IV] 2. Severe cardiac dysfunction (LVEF ≤ 30%), isolated RV failure (e.g., ARVC) or non-operable severe valve abnormalities or congenital abnormalities or persistently high (or increasing) BNP or NT-proBNP values and severe diastolic dysfunction or LV structural abnormalities according to HFpEF and HFmrEF ESC definitions 3. Severe impairment of exercise capacity of cardiac origin: 6 MWTD (< 300 m) or pVO2 (< 12-14 mL/kg/min)
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