Canadian Journal of Cardiology

Reappraisal of the Regurgitation Severity vs Left Ventricular Dilation Conceptual Framework for the Management of Secondary Mitral Regurgitation

Published:August 10, 2022DOI:
      Secondary mitral regurgitation (SMR) is a common and challenging cardiovascular disease. Transcatheter edge-to-edge repair (TEER) has emerged as an alternative to surgical mitral valve (MV) repair or replacement for the treatment of SMR. Although TEER has received approval from health regulatory services in numerous countries, controversies remain concerning which subtypes of patients benefit from the intervention and which may not. The concept of mitral regurgitation (MR) proportionality related to left ventricular (LV) dilation has been introduced as a potential explanation, but given the confusion and doubts observed in clinical practice, we feel it needs to be revisited from both mechanistic and clinical standpoints.
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        • Obadia J.F.
        • Messika-Zeitoun D.
        • Leurent G.
        • et al.
        Percutaneous repair or medical treatment for secondary mitral regurgitation.
        N Engl J Med. 2018; 379: 2297-2306
        • Stone G.W.
        • Lindenfeld J.
        • Abraham W.T.
        • et al.
        Transcatheter mitral-valve repair in patients with heart failure.
        N Engl J Med. 2018; 379: 2307-2318
        • Greyburn P.A.
        • Sannino A.
        • Packer M.
        Proportionate and disproportionate functional mitral regurgitation: a new conceptual framework that reconciles the results of the MITRA-FR and COAPT trials.
        JACC Cardiovasc Imaging. 2019; 12: 353-362
        • Orban M.
        • Karam N.
        • Lubos E.
        • et al.
        Impact of proportionality of secondary mitral regurgitation on outcome after transcatheter mitral valve repair.
        JACC Cardiovasc Imaging. 2021; 14: 715-725
        • Ooms J.F.
        • Bouwmeester S.
        • Debonnaire P.
        • et al.
        Transcatheter edge-to-edge repair in proportionate vs disproportionate functional mitral regurgitation.
        J Am Soc Echocardiogr. 2022; 35 (e108): 105-115