Heartbeat: Transcatheter procedures for secondary mitral regurgitation?

The development of transcatheter procedures to reduce the severity of mitral regurgitation (MR) provides a therapeutic alternative for patients with severe symptomatic primary MR who are at high risk for surgical intervention. It is less clear whether transcatheter mitral valve procedures are beneficial in patients with MR secondary to left ventricular (LV) systolic dysfunction or ischaemic heart disease. In a meta-analysis of 9 studies, including 2615 patients treated with a transcatheter mitral valve clip, Chiarito and colleagues1 found that patients with secondary MR had lower rates of mitral valve re-intervention at 1 year compared with those with primary MR (4% vs 10%; RR 0.60; 95% CI: 0.38 to 0.97). Residual MR was 2+or less in severity in most patients with either primary or secondary MR (58% vs 54%), with no differences in mortality, or device complications at 1 year (figure 1). However, secondary MR was associated with higher rates of persistent severe heart failure (16% vs 8%) and heart failure re-hospitalisation (23% vs 14%) compared with patients with primary MR. Figure 1 Risk estimates of overall mortality for functional mitral regurgitation versus degenerative mitral regurgitation. Forest plot shows results for overall mortality at 1 year. EVEREST II, Endovascular Valve Edge-to-Edge Repair Study II; RCT, randomised controlled trial. In an accompanying editorial, …