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Established interventions for mitral valve regurgitation

Current evidence

Etablierte Interventionen bei Mitralklappenregurgitation

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Abstract

Severe mitral regurgitation (MR) is a growing medical challenge in today’s aging population, leading to increased health expenditure due to the resultant morbidity and mortality. Surgery, either replacement or repair, has been the mainstay of therapy for primary MR. In high-risk or inoperable patients, treatment was limited to medical therapy until 2008. Since then, alternative percutaneous therapies have been introduced and have proven to be safe and effective in patients with secondary MR. Edge-to-edge repair with the MitraClip system is applied worldwide for primary and secondary MR. Randomized data do not support its application in low-risk patients with primary MR. Results from ongoing and future randomized trials will clarify its impact on important clinical endpoints in high-risk and inoperable patients. The Carillon device is a percutaneous indirect annuloplasty technique introduced in 2009 for secondary MR. Clinical data for the novel Cardioband system, using a different intra-atrial annuloplasty technique, have been gathered from more than 40 patients and the system recently received CE mark approval. Other percutaneous repair devices and implantable valves are under development and may be introduced into clinical practice soon. The percutaneous interventional therapy of MR is a highly dynamic field of cardiovascular medicine and has the potential to improve quality of life as well as morbidity and mortality in selected patients.

Zusammenfassung

Aufgrund der aktuellen demographischen Entwicklung wird die schwere symptomatische Mitralinsuffizienz in einer alternden Bevölkerung zunehmen. Dies wird zu steigenden Gesundheitsausgaben aufgrund der assoziierten Morbidität und Mortalität führen. Die Klappenoperation, insbesondere die rekonstruktive Klappenreparatur, ist der Grundpfeiler der Therapie der primären Mitralinsuffizienz. Die Versorgung von Hochrisiko- oder inoperablen Patienten war bis 2008 auf die medikamentöse Therapie begrenzt. Alternative perkutane Therapien sind seitdem entwickelt worden und haben sich bei Patienten mit sekundärer Mitralinsuffizienz als sicher und effektiv erwiesen. Die Edge-to-Edge-Reparatur mittels MitraClip wird weltweit bei primärer oder sekundärer Mitralinsuffizienz eingesetzt. Randomisierte Daten unterstützen hingegen nicht die Anwendung bei Niedrigrisikopatienten mit primärer Mitralinsuffizienz. Laufende und zukünftige randomisierte Studien werden den Einfluss auf harte klinische Endpunkte bei Hochrisiko- und inoperablen Patienten zeigen. Das Carillon-System stellt eine 2009 etablierte, perkutane Annuloplastietechnik via Sinus coronarius für sekundäre Mitralinsuffizienz dar, die in nichtrandomisierten Studien bei Patienten mit eingeschränkter linksventrikulärer Pumpfunktion eingesetzt wurde. Das Cardioband-System mit einer intraatrialen Annuloplastietechnik wurde bei mehr als 40 Patienten implantiert und hat kürzlich eine CE-Zertifizierung erhalten. Andere perkutane Reparatursysteme und implantierbare Klappen werden zurzeit entwickelt und könnten bald klinisch eingesetzt werden. Die perkutante interventionelle Therapie der Mitralinsuffizienz ist einer der dynamischsten Bereiche der kardiovaskulären Medizin und besitzt das Potenzial, die Lebensqualität, Morbidität und Sterblichkeit bei bestimmten Patienten zu verbessern.

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Authors and Affiliations

  1. Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Marchioninistr. 15, 81377, Munich, Germany

    Mathias Orban, D. Braun, Martin Orban, L. Gross, M. Näbauer, S. Massberg &  J. Hausleiter

  2. Herzchirurgische Klinik und Poliklinik, Klinikum der Universität München, Munich, Germany

    C.M. Hagl

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  1. Mathias Orban
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  2. D. Braun
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  3. Martin Orban
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Correspondence to J. Hausleiter.

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Mathias Orban, D. Braun, L. Gross, M. Näbauer, C.M. Hagl and S. Massberg state that there are no conflicts of interest.

J. Hausleiter received speaker honoraria from Abbott Vascular and Edwards Lifesciences. Martin Orban received travel grants from Abbott Vascular.

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Orban, M., Braun, D., Orban, M. et al. Established interventions for mitral valve regurgitation. Herz 41, 19–25 (2016). https://doi.org/10.1007/s00059-015-4386-0

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