Secondary MR and Percutaneous Interventions: Key Points
The following are key points to remember from a state-of-the-art review on treatment options for patients with secondary mitral regurgitation (SMR):
- MR is the most common valvular disease in the United States, and transcatheter interventions offer an effective treatment option for SMR.
- Utilization of imaging, including transesophageal echocardiography, cardiac magnetic resonance, and cardiac computed tomography is essential for diagnosis and procedural planning.
- A multidisciplinary heart team approach is recognized as best practice for managing patients with SMR. Their role includes collaboration to assess therapy options, timing of treatments, and optimization of medical therapy.
- Guideline-directed medical therapy is a cornerstone for treatment of SMR, but use is often complicated by underutilization, intolerance, or compliance issues.
- Cardiac resynchronization therapy and coronary revascularization should be considered for qualifying patients prior to transcatheter interventions.
- Surgical valve repair and replacement for SMR are given an American College of Cardiology/American Heart Association (ACC/AHA) guideline Class IIb recommendation when performed in isolation and ACC/AHA Class IIa recommendation during other cardiac surgeries.
- Transcatheter edge-to-edge repair is an ACC/AHA Class IIa recommendation for patients with severe, symptomatic SMR, who meet the COAPT trial inclusion criteria. Research is ongoing to determine benefit in other patient populations such as mild to moderate SMR and those with severe left ventricle (LV) dysfunction.
- Transcatheter mitral valve annuloplasty includes partial or full ring-based devices directly or indirectly implanted to reduce the mitral annulus dimension, improve coaptation of leaflets, and decrease SMR. Currently there are no Food and Drug Administration–approved devices for use and large randomized trials are needed to assess safety and benefit for SMR.
- Transcatheter mitral valve replacement includes use of a device inserted via the transseptal or transapical approach. These have shown promise in early trials, though implantation is more technically challenging than other transcatheter procedures and includes the need for long-term anticoagulation.
- Transcatheter LV restoration devices are currently being studied in clinical trials and include a system of anchors implanted at the inner wall of the LV below the mitral annulus. A cable attached to the anchors is cinched and creates a reduction in LV end-diastolic diameter.
https://onlinejcf.com/article/S1071-9164(24)00274-4/abstract
