Selection of the Optimal Candidate to MitraClip for Secondary Mitral Regurgitation: Beyond Mitral Valve Morphology

Frontiers in Cardiovascular Medicine

Corrado Fiore¹  Luca Testa²  Francesco Bedogni²  Antonio Popolo Rubbio²  Fabrizio Ricci³  George D. Dangas⁴  Bushra S. Rana⁵  Sabina Gallina⁶  Marianna Appignani⁶  Maria Di Fulvio⁶  Laura Ceriello⁶  Anna Laura Caterino⁶  Tanya Salvatore⁷  Marco Zimarino⁸  Mohammed Y. Khanji⁹ 

[1] Città di Lecce Hospital, Lecce, Italy;Department of Cardiology, IRCCS Pol. S. Donato, S. Donato Milanese, Milan, Italy;Department of Clinical Sciences, Clinical Research Center, Lund University, Malmö, Sweden;Department of Neuroscience, Imaging and Clinical Sciences, “G. d'Annunzio” University of Chieti-Pescara, Chieti, Italy;Casa di Cura Villa Serena, Città Sant'Angelo, Pescara, Italy;Icahn School of Medicine at Mount Sinai, The Zena and Michael A. Wiener Cardiovascular Institute, New York, NY, United States;Imperial College Healthcare Trust, Hammersmith and Charing Cross Hospitals, London, United Kingdom;Institute of Cardiology, “G. d'Annunzio” University of Chieti-Pescara, Chieti, Italy;Institute of Cardiology, “G. d'Annunzio” University of Chieti-Pescara, Chieti, Italy;Department of Cardiology, IRCCS Pol. S. Donato, S. Donato Milanese, Milan, Italy;Institute of Cardiology, “G. d'Annunzio” University of Chieti-Pescara, Chieti, Italy;Interventional Cath Lab, Chieti, Italy;NIHR Barts Biomedical Research Centre, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom;Barts Heart Centre, St. Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom;

关键词: MitraClip;    heart failure;    mitral regurgitation;    cardiac magnetic resonance;    echocardiography;    multimodality cardiac imaging;    mitral valve repair;   

DOI  :  10.3389/fcvm.2021.585415

来源: Frontiers

【 摘 要 】

Secondary mitral regurgitation (MR) occurs despite structurally normal valve apparatus due to an underlying disease of the myocardium leading to disruption of the balance between tethering and closing forces with ensuing failure of leaflet coaptation. In patients with heart failure (HF) and left ventricular dysfunction, secondary MR is independently associated with poor outcome, yet prognostic benefits related to the correction of MR have remained elusive. Surgery is not recommended for the correction of secondary MR outside coronary artery bypass grafting. Percutaneous mitral valve repair (PMVR) with MitraClip implantation has recently evolved as a new transcatheter treatment option of inoperable or high-risk patients with severe MR, with promising results supporting the extension of guideline recommendations. MitraClip is highly effective in reducing secondary MR in HF patients. However, the derived clinical benefit is still controversial as two randomized trials directly comparing PMVR vs. optimal medical therapy in severe secondary MR yielded virtually opposite conclusions. We reviewed current evidence to identify predictors of PMVR-related outcomes in secondary MR useful to improve the timing and the selection of patients who would derive maximal benefit from MitraClip intervention. Beyond mitral valve anatomy, optimal candidate selection should rely on a comprehensive diagnostic workup and a fine-tuned risk stratification process aimed at (i) recognizing the substantial heterogeneity of secondary MR and its complex interaction with the myocardium, (ii) foreseeing hemodynamic consequences of PMVR, (iii) anticipating futility and (iv) improving symptoms, quality of life and overall survival.

【 授权许可】

CC BY