Percutaneous treatment of mitral regurgitation: looking for a final model

  • Marianna Adamo
  • Marco MetraEmail author

Transcatheter mitral valve therapy (TMVT) has emerged as an alternative to surgery for treating patients with heart failure (HF) and primary or secondary mitral regurgitation (MR) [1, 2]. The most widely adopted technique, to date, is the edge-to-edge repair using the Mitraclip device. Among Mitraclip recipients, about 70% are affected by secondary (functional) MR [1, 2]. The distinction between primary and secondary MR is paramount. Primary MR is a valve’s disease, which can lead to left ventricular (LV) remodelling if not treated. Therefore, current guidelines recommend mitral valve surgery in patients with severe primary MR and symptoms and/or initial overload of left chambers [3]. In this setting TMVT (i.e. Mitraclip) can be considered as an alternative to surgery in patients deemed inoperable or at high-risk due to comorbidities, elderly age or frailty [3]. On the other hand, secondary MR is a ventricle’s disease in presence of a normal mitral valve anatomy. In the latter case,...


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Conflict of interest

M. Adamo has not competing interests. M. Metra received honoraria for speeches from Abbott and Edwards and is involved as member of Committees for clinical trials or as advisory board member from Abbott, AMGEN, Astra-Zeneca, Fresenius, Novartis, Servier, Vifor.

Statement of human and animal rights

This article does not contain any studies with human participants or animals performed by any of the authors.

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  1. 1.
    Nickenig G, Estevez-Loureiro R, Franzen O, Tamburino C, Vanderheyden M, Lüscher TF, Moat N, Price S, Dall’Ara G, Winter R, Corti R, Grasso C, Snow TM, Jeger R, Blankenberg S, Settergren M, Tiroch K, Balzer J, Petronio AS, Büttner HJ, Ettori F, Sievert H, Fiorino MG, Claeys M, Ussia GP, Baumgartner H, Scandura S, Alamgir F, Keshavarzi F, Colombo A, Maisano F, Ebelt H, Aruta P, Lubos E, Plicht B, Schueler R, Pighi M, Di Mario C; Transcatheter Valve Treatment Sentinel Registry Investigators of the EURObservational Research Programme of the European Society of Cardiology (2014) Percutaneous mitral valve edge-to-edge repair: in-hospital results and 1-year follow-up of 628 patients of the 2011–2012 Pilot European Sentinel Registry. J Am Coll Cardiol 64:875–884Google Scholar
  2. 2.
    Maisano F, Franzen O, Baldus S, Schäfer U, Hausleiter J, Butter C, Ussia GP, Sievert H, Richardt G, Widder JD, Moccetti T, Schillinger W (2013) Percutaneous mitral valve interventions in the real world: early and 1-year results from the ACCESS-EU, a prospective, multicenter, nonrandomized post-approval study of the MitraClip therapy in Europe. J Am Coll Cardiol 62:1052–1061CrossRefGoogle Scholar
  3. 3.
    Baumgartner H, Falk V, Bax JJ, De Bonis M, Hamm C, Holm PJ, Iung B, Lancellotti P, Lansac E, Rodriguez Muñoz D, Rosenhek R, Sjögren J, Tornos Mas P, Vahanian A, Walther T, Wendler O, Windecker S, Zamorano JL; ESC Scientific Document Group (2017) 2017 ESC/EACTS Guidelines for the management of valvular heart disease. Eur Heart J 38(36):2739–2791Google Scholar
  4. 4.
    Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JG, Coats AJ, Falk V, González-Juanatey JR, Harjola VP, Jankowska EA, Jessup M, Linde C, Nihoyannopoulos P, Parissis JT, Pieske B, Riley JP, Rosano GM, Ruilope LM, Ruschitzka F, Rutten FH, van der Meer P (2016) 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur J Heart Fail 18:891–975Google Scholar
  5. 5.
    Feldman T, Foster E, Glower DD, Kar S, Rinaldi MJ, Fail PS, Smalling RW, Siegel R, Rose GA, Engeron E, Loghin C, Trento A, Skipper ER, Fudge T, Letsou GV,Massaro JM, Mauri L; EVEREST II Investigators (2011) Percutaneous repair or surgery for mitral regurgitation. N Engl J Med 364:1395–1406CrossRefGoogle Scholar
  6. 6.
    Bini T, Agostini C, Stolcova M, Meucci F, Di Mario C (2019) One more option in heart failure: correction of mitral regurgitation with MitraClip®. Intern Emerg Med. 14(7):1033–1040CrossRefGoogle Scholar
  7. 7.
    Obadia JF, Messika-Zeitoun D, Leurent G, Iung B, Bonnet G, Piriou N, Lefèvre T, Piot C, Rouleau F, Carrié D, Nejjari M, Ohlmann P, Leclercq F, Saint Etienne C, Teiger E, Leroux L, Karam N, Michel N, Gilard M, Donal E, Trochu JN, Cormier B, Armoiry X, Boutitie F, Maucort-Boulch D, Barnel C, Samson G, Guerin P, Vahanian A, Mewton N; MITRA-FR Investigators (2018) Percutaneous repair or medical treatment for secondary mitral regurgitation. N Engl J Med 379(24):2297–2306CrossRefGoogle Scholar
  8. 8.
    Iung B, Armoiry X, Vahanian A, Boutitie F, Mewton N, Trochu JN, Lefèvre T, Messika-Zeitoun D, Guerin P, Cormier B, Brochet E, Thibault H, Himbert D, Thivolet S, Leurent G, Bonnet G, Donal E, Piriou N, Piot C, Habib G, Rouleau F, Carrié D, Nejjari M, Ohlmann P, Etienne CS, Leroux L, Gilard M, Samson G, Rioufol G, Maucort-Boulch D, Obadia JF; MITRA-FR Investigators (2019) Percutaneous repair or medical treatment for secondary mitral regurgitation: outcomes at 2 years. Eur J Heart Fail 21(12):1619–1627Google Scholar
  9. 9.
    Stone GW, Lindenfeld J, Abraham WT, Kar S, Lim DS, Mishell JM, Whisenant B, Grayburn PA, Rinaldi M, Kapadia SR, Rajagopal V, Sarembock IJ, Brieke A, Marx SO, Cohen DJ, Weissman NJ, Mack MJ; COAPT Investigators (2018) Transcatheter mitral-valve repair in patients with heart failure. N Engl J Med 379(24):2307–2318CrossRefGoogle Scholar
  10. 10.
    Senni M, Adamo M, Metra M, Alfieri O, Vahanian A (2019) Treatment of functional mitral regurgitation in chronic heart failure: can we get a 'proof of concept' from the MITRA-FR and COAPT trials? Eur J Heart Fail. 21(7):852–861CrossRefGoogle Scholar
  11. 11.
    Geis NA, Puls M, Lubos E, Zuern CS, Franke J, Schueler R, von Bardeleben RS, Boekstegers P, Ouarrak T, Zahn R, Ince H, Senges J, Katus HA, Bekeredjian R (2018) Safety and efficacy of MitraClip™ therapy in patients with severely impaired left ventricular ejection fraction: results from the German transcatheter mitral valve interventions (TRAMI) registry. Eur J Heart Fail. 20(3):598–608CrossRefGoogle Scholar
  12. 12.
    Tigges E, Blankenberg S, von Bardeleben RS, Zürn C, Bekeredjian R, Ouarrak T, Sievert H, Nickenig G, Boekstegers P, Senges J, Schillinger W, Lubos E (2018) Implication of pulmonary hypertension in patients undergoing MitraClip therapy: results from the German transcatheter mitral valve interventions (TRAMI) registry. Eur J Heart Fail 20(3):585–594CrossRefGoogle Scholar
  13. 13.
    Keßler M, Seeger J, Muche R, Wöhrle J, Rottbauer W, Markovic S (2019) Predictors of rehospitalization after percutaneous edge-to-edge mitral valve repair by MitraClip implantation. Eur J Heart Fail 21(2):182–192CrossRefGoogle Scholar
  14. 14.
    Capodanno D, Adamo M, Barbanti M, Giannini C, Laudisa ML, Cannata S, Curello S, Immè S, Maffeo D, Bedogni F, Petronio AS, Ettori F, Tamburino C, Grasso C; GRASP-IT Investigators (2015) Predictors of clinical outcomes after edge-to-edge percutaneous mitral valve repair. Am Heart J 170:187–195Google Scholar
  15. 15.
    Praz F, Grasso C, Taramasso M, Baumbach A, Piazza N, Tamburino C, Windecker S, Maisano F, Prendergast B (2019) Mitral regurgitation in heart failure: time for a rethink. Eur Heart J 40(27):2189–2193CrossRefGoogle Scholar
  16. 16.
    Grayburn PA, Sannino A, Packer M (2018) Proportionate and disproportionate functional mitral regurgitation: a new conceptual framework that reconciles the results of the MITRA-FR and COAPT trials. JACC Cardiovasc Imaging 12:353–362CrossRefGoogle Scholar
  17. 17.
    Packer M (2019) Disproportionate functional mitral regurgitation: a new therapeutic target in patients with heart failure and a reduced ejection fraction. Eur J Heart Fail. CrossRefPubMedPubMedCentralGoogle Scholar

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© Società Italiana di Medicina Interna (SIMI) 2020

Authors and Affiliations

  1. 1.Cardio-Thoracic DepartmentCivil HospitalsBresciaItaly
  2. 2.Department of Medical and Surgical Specialties, Radiological Sciences, and Public HealthUniversity of BresciaBresciaItaly

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