The current role of MitraClip in the treatment of mitral regurgitation: What the studies and clinical practice say

Abstract

The treatment of symptomatic primary mitral regurgitation is guided by symptoms and assessment of ventricular function and size, atrial fibrillation, pulmonary hypertension, and left atrial size, with mitral valve repair being the preferred method and mitral valve replacement being used in the case of unfavorable morphology. In secondary mitral regurgitation, there is no conclusive evidence for survival benefit after mitral valve intervention. Over the last few years, less invasive catetheter-based systems have been subjected to clinical trial (whose brief oveview is given), but only MitraClip implantation (as a method of creating edge-toedge mitral valve repair) has sufficient clinical evidence. Two randomized clinical trials compared transcatetheter mitral valve repair with optimal medical therapy in heart failure patients with secondary mitral regurgitation. In the MITRA-FR trial, the primary outcome of combined all-cause mortality or heart failure associated hospitalization at one year was not different (54.6 % vs. 51.3 %, p =, 53). But in contrast, in the COAPT trial significant reduction of mortality (29.1 % vs. 46.1 %, p < 0.001) and heart failure hospitalizations (35.8 % vs 67.9 % per patient-year, p < 0.001) in the MitraClip group was achieved. The degree of mitral regurgitation in the context of left ventricular dilatation and classification of mitral regurgitation into "proportionate" and "disproportionate" can both aid in choosing an optimal treatment.