Severe secondary mitral regurgitation and left ventricular dysfunction: a 'deadly combination' against which the fight is not over!

Abstract

This editorial refers to ‘Management and outcomes in patients with moderate or severe functional mitral regurgitation and severe left ventricular dysfunction’, by Z. Samad et al ., on page doi:10.1093/eurheartj/ehv343. The management of patients with severe secondary (also called functional) mitral regurgitation (MR) and left ventricular (LV) dysfunction is a topic of interest because it concerns many patients who have a poor prognosis,1–3 and the data currently available on the impact of different treatments are somewhat discordant.4–9 Therefore current recommendations for interventions in both the European and US guidelines are restrictive, with a low level of evidence.10–13 The study by Samad is an important one in the field.14 The study population results from the merging of two large databases from Duke University putting together a record of 1441 patients with moderate to severe functional MR and LV dysfunction. The first goal of this contemporary study was to describe current practices. It confirmed that medical management is the most popular strategy, which was used in 75% of patients. Percutaneous coronary intervention was used in 8%, coronary bypass surgery (CABG) in 6%, CABG plus mitral valve surgery in 7%, and finally mitral valve surgery in isolation in 4% of cases. This is the basis for the choice of medical treatment as a comparator with MitraClip …