Treatment of Functional Mitral Regurgitation in Heart Failure

Enrico Fabris; Antonio De Luca; Giancarlo Vitrella; Davide Stolfo; Marco Mase; Renata Korcova; Marco Merlo; Serena Rakar; Arnoud W. J. van't Hof; Elvin Kedhi; Andrea Perkan; Gianfranco Sinagra

doi:10.1007/s11886-019-1221-x

Treatment of Functional Mitral Regurgitation in Heart Failure

Enrico Fabris^*, Antonio De Luca, Giancarlo Vitrella, Davide Stolfo, Marco Mase, Renata Korcova, Marco Merlo, Serena Rakar, Arnoud W. J. van't Hof, Elvin Kedhi, Andrea Perkan, Gianfranco Sinagra

^*Corresponding author for this work

Research output: Contribution to journal › (Systematic) Review article › peer-review

Abstract

Purpose of Review To analyze the current state of the art of functional mitral regurgitation (FMR) treatment. Recent Findings The first-line treatment of severe FMR consists of guideline medical therapy (GMT) and resynchronization therapy when indicated; the impact of new medical therapies like sacubitril/valsartan needs further assessment. Valvular intervention may be considered in FMR symptomatic patients despite GMT, and can be performed surgically or percutaneously. MitraClip is a safe percutaneous procedure associated with symptoms improvement. Recently, the COAPT trial showed superior outcomes for MitraClip versus GMT contrasting the MITRA-FR trial which showed no benefit of MitraClip compared with GMT. These results should be interpreted as complementary rather than opposite. The COAPT trial provided a "proof of concept" that percutaneous treatment of severe FMR in patients without too advanced left ventricular disease translates into a prognostic benefit. Careful patient selection will play a critical role in defining the clinical niche for successful interventions.

Original language	English
Article number	139
Number of pages	12
Journal	Current Cardiology Reports
Volume	21
Issue number	11
DOIs	https://doi.org/10.1007/s11886-019-1221-x
Publication status	Published - Nov 2019

Keywords

Functional mitral regurgitation
Mitral valve repair
Transcatheter interventions
MitraClip
Heart failure
Heart team
CARDIAC RESYNCHRONIZATION THERAPY
NATIVE VALVULAR REGURGITATION
VALVE REPAIR
EUROPEAN ASSOCIATION
PERCUTANEOUS REPAIR
CLINICAL-OUTCOMES
ANNULOPLASTY
PREDICTORS
CARDIOMYOPATHY
IMPACT

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10.1007/s11886-019-1221-x

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title = "Treatment of Functional Mitral Regurgitation in Heart Failure",

abstract = "Purpose of Review To analyze the current state of the art of functional mitral regurgitation (FMR) treatment. Recent Findings The first-line treatment of severe FMR consists of guideline medical therapy (GMT) and resynchronization therapy when indicated; the impact of new medical therapies like sacubitril/valsartan needs further assessment. Valvular intervention may be considered in FMR symptomatic patients despite GMT, and can be performed surgically or percutaneously. MitraClip is a safe percutaneous procedure associated with symptoms improvement. Recently, the COAPT trial showed superior outcomes for MitraClip versus GMT contrasting the MITRA-FR trial which showed no benefit of MitraClip compared with GMT. These results should be interpreted as complementary rather than opposite. The COAPT trial provided a {"}proof of concept{"} that percutaneous treatment of severe FMR in patients without too advanced left ventricular disease translates into a prognostic benefit. Careful patient selection will play a critical role in defining the clinical niche for successful interventions.",

keywords = "Functional mitral regurgitation, Mitral valve repair, Transcatheter interventions, MitraClip, Heart failure, Heart team, CARDIAC RESYNCHRONIZATION THERAPY, NATIVE VALVULAR REGURGITATION, VALVE REPAIR, EUROPEAN ASSOCIATION, PERCUTANEOUS REPAIR, CLINICAL-OUTCOMES, ANNULOPLASTY, PREDICTORS, CARDIOMYOPATHY, IMPACT",

author = "Enrico Fabris and {De Luca}, Antonio and Giancarlo Vitrella and Davide Stolfo and Marco Mase and Renata Korcova and Marco Merlo and Serena Rakar and {van't Hof}, {Arnoud W. J.} and Elvin Kedhi and Andrea Perkan and Gianfranco Sinagra",

note = "Publisher Copyright: {\textcopyright} 2019, Springer Science+Business Media, LLC, part of Springer Nature.",

year = "2019",

month = nov,

doi = "10.1007/s11886-019-1221-x",

language = "English",

volume = "21",

journal = "Current Cardiology Reports",

issn = "1523-3782",

publisher = "Current Medicine Group",

number = "11",

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T1 - Treatment of Functional Mitral Regurgitation in Heart Failure

AU - Fabris, Enrico

AU - De Luca, Antonio

AU - Vitrella, Giancarlo

AU - Stolfo, Davide

AU - Mase, Marco

AU - Korcova, Renata

AU - Merlo, Marco

AU - Rakar, Serena

AU - van't Hof, Arnoud W. J.

AU - Kedhi, Elvin

AU - Perkan, Andrea

AU - Sinagra, Gianfranco

PY - 2019/11

Y1 - 2019/11

N2 - Purpose of Review To analyze the current state of the art of functional mitral regurgitation (FMR) treatment. Recent Findings The first-line treatment of severe FMR consists of guideline medical therapy (GMT) and resynchronization therapy when indicated; the impact of new medical therapies like sacubitril/valsartan needs further assessment. Valvular intervention may be considered in FMR symptomatic patients despite GMT, and can be performed surgically or percutaneously. MitraClip is a safe percutaneous procedure associated with symptoms improvement. Recently, the COAPT trial showed superior outcomes for MitraClip versus GMT contrasting the MITRA-FR trial which showed no benefit of MitraClip compared with GMT. These results should be interpreted as complementary rather than opposite. The COAPT trial provided a "proof of concept" that percutaneous treatment of severe FMR in patients without too advanced left ventricular disease translates into a prognostic benefit. Careful patient selection will play a critical role in defining the clinical niche for successful interventions.

AB - Purpose of Review To analyze the current state of the art of functional mitral regurgitation (FMR) treatment. Recent Findings The first-line treatment of severe FMR consists of guideline medical therapy (GMT) and resynchronization therapy when indicated; the impact of new medical therapies like sacubitril/valsartan needs further assessment. Valvular intervention may be considered in FMR symptomatic patients despite GMT, and can be performed surgically or percutaneously. MitraClip is a safe percutaneous procedure associated with symptoms improvement. Recently, the COAPT trial showed superior outcomes for MitraClip versus GMT contrasting the MITRA-FR trial which showed no benefit of MitraClip compared with GMT. These results should be interpreted as complementary rather than opposite. The COAPT trial provided a "proof of concept" that percutaneous treatment of severe FMR in patients without too advanced left ventricular disease translates into a prognostic benefit. Careful patient selection will play a critical role in defining the clinical niche for successful interventions.

KW - Functional mitral regurgitation

KW - Mitral valve repair

KW - Transcatheter interventions

KW - MitraClip

KW - Heart failure

KW - Heart team

KW - CARDIAC RESYNCHRONIZATION THERAPY

KW - NATIVE VALVULAR REGURGITATION

KW - VALVE REPAIR

KW - EUROPEAN ASSOCIATION

KW - PERCUTANEOUS REPAIR

KW - CLINICAL-OUTCOMES

KW - ANNULOPLASTY

KW - PREDICTORS

KW - CARDIOMYOPATHY

KW - IMPACT

U2 - 10.1007/s11886-019-1221-x

DO - 10.1007/s11886-019-1221-x

M3 - (Systematic) Review article

C2 - 31734930

SN - 1523-3782

VL - 21

JO - Current Cardiology Reports

JF - Current Cardiology Reports

IS - 11

M1 - 139

ER -

Treatment of Functional Mitral Regurgitation in Heart Failure

Abstract

Keywords

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