Waiting to Exhale
Transcatheter Repair of Mitral Regurgitation and Survival
This article requires a subscription to view the full text. If you have a subscription you may use the login form below to view the article. Access to this article can also be purchased.
Mitral regurgitation (MR) is the most common valvular disease in Western countries, affecting 2 to 4 million people in the United States alone.1 When severe and left untreated, MR leads to adverse ventricular remodeling and, in many patients, impaired survival with a high rate of morbidity because of heart failure. For primary MR, surgery, particularly valve repair, is the standard of care and is recommended for patients with either symptoms or significant left ventricular dysfunction.2 Conversely, guideline-directed medical therapy is emphasized for patients with secondary MR and typically consists of β-receptor blockers, vasodilators, diuretics, and aldosterone antagonists, with or without cardiac resynchronization.3 For secondary MR, such therapy targets ventricular dysfunction as the cause of MR and has established efficacy for improving symptoms and the prognosis of patients with heart failure.3
See Article by Kortlandt et al
Transcatheter mitral repair with MitraClip (Abbott Vascular, Menlo Park, CA) first became available for high-risk or inoperable patients in 2008, when it received Conformité Européene mark for clinical use in those with primary or secondary MR in Europe. Agency approval in the United States (primary only) and parts of Asia (primary or secondary or both) soon followed, with the most recent commercial launch occurring in Japan earlier this year. The broad, multinational adoption of transcatheter repair of MR with MitraClip is notable, particularly given (1) the relatively small size of the reported randomized clinical trials of this therapy, (2) the absence of demonstrated superior efficacy of the therapy in comparison with current standards for MR treatment, and (3) for patients with secondary MR, the considerable controversy regarding the benefits of MR correction by any means, be it surgical or transcatheter. Indeed, practice guidelines have given a class IIb recommendation for transcatheter repair of MR (primary or secondary MR in Europe; …