Outcomes with percutaneous mitral repair vs. optimal medical treatment for functional mitral regurgitation: systematic review

Abstract

Functional mitral regurgitation (MR) could be defined as a ventricular disease where mitral valve is structurally normal, left chambers are enlarged and mitral annulus is dilated with lack of coaptation of leaflets. Transcatheter mitral valve repair technique has broadened the therapeutic range in the treatment of severe MR. The aim of this study was to review outcomes of MitraClip vs. medical treatment for functional MR. We also planned to review the concept of functional MR, assessment of the degree, prognosis and therapy options. This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The Medline through PubMed database was used to search. The present review included manuscripts published between January 2009 and September 2019. Two authors independently screened titles and abstracts of all publications, and performed the selection of studies and data extraction. In the case of disagreements, consensus meetings reached the final decision. Inclusion criteria were: (I) randomized controlled trials and (II) works must compare MitraClip versus optimal medical treatment. Transcatheter mitral valve repair along optimal medical treatment has been compared with optimal medical therapy in two different randomized trials. In the COAPT trial, the MitraClip group showed a significant reduction in mortality and heart failure (HF) hospitalizations. In the MITRA-FR trial, no significant differences were observed between both groups. We reviewed important aspects of functional MR and performed a comprehensive review of both trials comparing them and focusing on their differences.

Quadrangular resection versus chordal replacement for degenerative posterior mitral leaflet prolapse

“…Although excellent short-and long-term outcomes have been reported by previous studies (2,6), underlying differences at follow-up between these two techniques with opposite principle remain, as well as risk factors for MR recurrence. A recently published article tried exploring this question, with a relatively small sample size and mostly covering patients with single segmental prolapse, while those with multi-segmental disease were prevalent but overlooked (17).…”

“…To remove the prolapsed or redundant posterior leaflet, a standard quadrangular resection was used (6,8). In most cases, detaching the quadrangular prolapsed leaflet from the Non-degenerative valve disease n=488…”

“…Isolated posterior leaflet prolapse is the most common abnormality seen in degenerative mitral regurgitation (MR), and is the main etiology of mitral valve (MV) disease in Western countries, which is gradually becoming prevalent worldwide (1,2). MV repair is increasingly used to restore leaflet morphology and left ventricular (LV) function due to its excellent long-term outcomes, and is the recommended treatment in clinical guidelines (3)(4)(5)(6)(7). Leaflet resection and chordal replacement are repair techniques that continue to evolve.…”

“…The chordal replacement technique, which was initially used in anterior mitral leaflet prolapse (13), became widely used in PML repair and an alternative to preserving complete tissue (14,15). As a means of functional restoration, chordal replacement was devised to maintain normal geometry and movement of the valvular apparatus throughout the cardiac cycle, therefore permit better ventricular performance (6). But the excess leaflet going along with billowing, is the result of the pathologic process sometimes, of which that reservation may leads to concerns about adverse events like systolic anterior motion (SAM) and recurring leaflet prolapse (16).…”

Asian Pacific Society of Cardiology Consensus Recommendations on the Use of MitraClip for Mitral Regurgitation

“…DMR, wherein one of the components of the mitral apparatus (leaflets, chords or papillary muscles) is affected, is often the result of degenerative mitral valve disease characterised by morphological changes in the connective tissue of the valve over time and resulting in MR.[ 10 , 11 ] DMR may be either the result of fibroelastic deficiency or due to diffuse myxomatous disease. [ 12 , 13 ] It may present across a spectrum ranging from isolated prolapse of a single leaflet scallop to bileaflet prolapse and annular dilation.…”