Key result
Percutaneous mitral valve leaflet repair outcomes are highly dependent on patient selection, timing, and operator experience, with real-world registries complementing randomized trial data.
Why the study?
Major clinical trials in percutaneous mitral valve leaflet repair have provided opposing evidence, leaving the field controversial and many questions open regarding patient selection, timing, and procedural details.
This review highlights the importance of real-world registries, patient selection, and operator-dependent factors in optimizing outcomes for percutaneous mitral valve leaflet repair.
Multiple devices now broaden mitral leaflet repair options; leaves optimal device selection open for high-risk patients.
Percutaneous mitral valve leaflet repair has revolutionised the treatment of heart failure patients with secondary mitral regurgitation. It also offers a valuable alternative to surgery for high-risk patients with degenerative disease. More than one device is now available for leaflet repair, broadening the indications and improving outcomes, as well as complicating the decision-making algorithms. In the last two years, several trials and registries have enriched the evidence around these procedures, although many questions remain open. Two major clinical trials have provided opposing evidence, confirming that this field of cardiovascular medicine remains controversial. Probably, the challenge remains with the human factor: achieving optimal outcomes remains a challenge, highly dependent on patient selection, timing and procedural details. Operator-dependent factors are emerging as a key element, not unexpectedly, to achieve procedural excellence. Besides large randomised controlled trials, a great deal of knowledge is emerging from real-world registries. This review focuses on what we can learn from registries and single-centre experiences as a complement to the large randomised trials.
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Maisano et al. (2020) conducted a review in Heart failure with secondary mitral regurgitation. Percutaneous mitral valve leaflet repair was evaluated. Percutaneous mitral valve leaflet repair outcomes are highly dependent on patient selection, timing, and operator experience, with real-world registries complementing randomized trial data.
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