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Treatment of Functional Mitral Regurgitation in Heart Failure

  • Myocardial Disease (A Abbate and G Sinagra, Section Editors)
  • Published:
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Abstract

Purpose of Review

To analyze the current state of the art of functional mitral regurgitation (FMR) treatment.

Recent Findings

The first-line treatment of severe FMR consists of guideline medical therapy (GMT) and resynchronization therapy when indicated; the impact of new medical therapies like sacubitril/valsartan needs further assessment. Valvular intervention may be considered in FMR symptomatic patients despite GMT, and can be performed surgically or percutaneously. MitraClip is a safe percutaneous procedure associated with symptoms improvement. Recently, the COAPT trial showed superior outcomes for MitraClip versus GMT contrasting the MITRA-FR trial which showed no benefit of MitraClip compared with GMT. These results should be interpreted as complementary rather than opposite.

Summary

The COAPT trial provided a “proof of concept” that percutaneous treatment of severe FMR in patients without too advanced left ventricular disease translates into a prognostic benefit. Careful patient selection will play a critical role in defining the clinical niche for successful interventions.

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Authors and Affiliations

  1. Cardiovascular Department, University of Trieste, Via Valdoni 7, 34129, Trieste, Italy

    Enrico Fabris, Antonio De Luca, Giancarlo Vitrella, Davide Stolfo, Marco Masè, Renata Korcova, Marco Merlo, Serena Rakar, Andrea Perkan & Gianfranco Sinagra

  2. Department of Cardiology, Maastricht University Medical Center, Maastricht, the Netherlands

    Arnoud W. J. van’t Hof

  3. Department of Cardiology, Zuyderland Medical Center, Heerlen, the Netherlands

    Arnoud W. J. van’t Hof

  4. AZ Sint-Jan Brugge, Bruges, Belgium

    Elvin Kedhi

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Enrico Fabris, Antonio De Luca, Giancarlo Vitrella, Davide Stolfo, Marco Masè, Renata Korcova, Marco Merlo, Serena Rakar, Elvin Kedhi and Andrea Perkan declare that they have no conflict of interest.

Arnoud WJ van’t Hof reports grants from Medtronic and Abbott, and personal fees from AstraZeneca.

Gianfranco Sinagra reports personal fees from Novartis, Vifor pharma, Boston, Bayer, AstraZeneca, and Dompè.

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Fabris, E., De Luca, A., Vitrella, G. et al. Treatment of Functional Mitral Regurgitation in Heart Failure. Curr Cardiol Rep 21, 139 (2019). https://doi.org/10.1007/s11886-019-1221-x

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