Current state and challenges of transcatheter therapy for secondary mitral regurgitation_West China Medical Journal

Authors：

YAO Yijun , CHEN Fei , FENG Yuan ,  CHEN Mao

Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

CHEN Mao, Email: hmaochen@vip.sina.com

Keywords：

Secondary mitral valve regurgitation; Transcatheter mitral valve repair; Transcatheter mitral valve replacement; Patient assessment

DOI：

10.7507/1002-0179.202107288

Video：

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Mitral valve regurgitation is one of the most common heart valve diseases, of which secondary mitral valve regurgitation (sMR) has large proportion and poor prognosis. For patients who still have symptoms after the guideline-directed management and therapy, the effects of surgery are controversial, and transcatheter therapy provides a new option. Transcatheter edge-to-edge repair has become one of the recommended therapies by the guidelines, meanwhile transcatheter mitral valve annuloplasty and transcatheter mitral valve replacement are developing. However, the etiological mechanism of sMR is complex and diverse. There is an interaction between cardiac function and structure and sMR in dynamic change. It brings challenges to the selection of indicators and evaluation timing. The complex anatomical structure also makes it more difficult to design instruments and select surgical methods. This paper reviews the challenges and progress of transcatheter therapy for sMR.

Citation： YAO Yijun, CHEN Fei, FENG Yuan, CHEN Mao. Current state and challenges of transcatheter therapy for secondary mitral regurgitation. West China Medical Journal, 2021, 36(9): 1244-1249. doi: 10.7507/1002-0179.202107288 Copy

1.	Monteagudo Ruiz JM, Galderisi M, Buonauro A, et al. Overview of mitral regurgitation in Europe: results from the European Registry of mitral regurgitation (EuMiClip). Eur Heart J Cardiovasc Imaging, 2018, 19(5): 503-507.
2.	Nkomo VT, Gardin JM, Skelton TN, et al. Burden of valvular heart diseases: a population-based study. Lancet, 2006, 368(9540): 1005-1011.
3.	叶蕴青, 许海燕, 李喆, 等. 中国不同区域老年瓣膜性心脏病构成和病因分析. 中华老年心脑血管病杂志, 2019, 21(7): 676-682.
4.	Dziadzko V, Clavel MA, Dziadzko M, et al. Outcome and undertreatment of mitral regurgitation: a community cohort study. Lancet, 2018, 391(10124): 960-969.
5.	Dziadzko V, Dziadzko M, Medina-Inojosa JR, et al. Causes and mechanisms of isolated mitral regurgitation in the community: clinical context and outcome. Eur Heart J, 2019, 40(27): 2194-2202.
6.	Asgar AW, Mack MJ, Stone GW. Secondary mitral regurgitation in heart failure: pathophysiology, prognosis, and therapeutic considerations. J Am Coll Cardiol, 2015, 65(12): 1231-1248.
7.	Nishimura RA, Otto CM, Bonow RO, et al. 2017 AHA/ACC focused update of the 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation, 2017, 135(25): e1159-e1195.
8.	Bartko PE, Heitzinger G, Pavo N, et al. Burden, treatment use, and outcome of secondary mitral regurgitation across the spectrum of heart failure: observational cohort study. BMJ, 2021, 373: n1421.
9.	Benfari G, Antoine C, Essayagh B, et al. Functional mitral regurgitation outcome and grading in heart failure with reduced ejection fraction. JACC Cardiovasc Imaging, 2021: S1936-878X(21)00437-X.
10.	Otto CM, Nishimura RA, Bonow RO, et al. 2020 ACC/AHA guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol, 2021, 77(4): e25-e197.
11.	Baumgartner H, Falk V, Bax JJ, et al. 2017 ESC/EACTS guidelines for the management of valvular heart disease. Eur Heart J, 2017, 38(36): 2739-2791.
12.	Bonow RO, O’Gara PT, Adams DH, et al. 2020 focused update of the 2017 ACC expert consensus decision pathway on the management of mitral regurgitation: a report of the American College of Cardiology Solution Set Oversight Committee. J Am Coll Cardiol, 2020, 75(17): 2236-2270.
13.	Maddox TM, Januzzi JL Jr, Allen LA, et al. 2021 update to the 2017 ACC expert consensus decision pathway for optimization of heart failure treatment: answers to 10 pivotal issues about heart failure with reduced ejection fraction: a report of the American College of Cardiology Solution Set Oversight Committee. J Am Coll Cardiol, 2021, 77(6): 772-810.
14.	Yancy CW, Jessup M, Bozkurt B, et al. 2017 ACC/AHA/HFSA focused update of the 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology/American Heart Association Task Force on clinical practice guidelines and the heart failure society of America. Circulation, 2017, 136(6): e137-e161.
15.	Chan KM, Punjabi PP, Flather M, et al. Coronary artery bypass surgery with or without mitral valve annuloplasty in moderate functional ischemic mitral regurgitation: final results of the randomized ischemic mitral evaluation (RIME) trial. Circulation, 2012, 126(21): 2502-2510.
16.	Fattouch K, Guccione F, Sampognaro R, et al. POINT: efficacy of adding mitral valve restrictive annuloplasty to coronary artery bypass grafting in patients with moderate ischemic mitral valve regurgitation: a randomized trial. J Thorac Cardiovasc Surg, 2009, 138(2): 278-285.
17.	Michler RE, Smith PK, Parides MK, et al. Two-year outcomes of surgical treatment of moderate ischemic mitral regurgitation. N Engl J Med, 2016, 374(20): 1932-1941.
18.	Smith PK, Puskas JD, Ascheim DD, et al. Surgical treatment of moderate ischemic mitral regurgitation. N Engl J Med, 2014, 371(23): 2178-2188.
19.	Alfieri O, Maisano F, De Bonis M, et al. The double-orifice technique in mitral valve repair: a simple solution for complex problems. J Thorac Cardiovasc Surg, 2001, 122(4): 674-681.
20.	Maisano F, Caldarola A, Blasio A, et al. Midterm results of edge-to-edge mitral valve repair without annuloplasty. J Thorac Cardiovasc Surg, 2003, 126(6): 1987-1997.
21.	Condado JA, Acquatella H, Rodriguez L, et al. Percutaneous edge-to-edge mitral valve repair: 2-year follow-up in the first human case. Catheter Cardiovasc Interv, 2006, 67(2): 323-325.
22.	Feldman T, Wasserman HS, Herrmann HC, et al. Percutaneous mitral valve repair using the edge-to-edge technique: six-month results of the EVEREST phaseⅠclinical trial. J Am Coll Cardiol, 2005, 46(11): 2134-2140.
23.	Whitlow PL, Feldman T, Pedersen WR, et al. Acute and 12-month results with catheter-based mitral valve leaflet repair: the EVERESTⅡ (endovascular valve edge-to-edge repair) high risk study. J Am Coll Cardiol, 2012, 59(2): 130-139.
24.	Obadia JF, Messika-Zeitoun D, Leurent G, et al. Percutaneous repair or medical treatment for secondary mitral regurgitation. N Engl J Med, 2018, 379(24): 2297-2306.
25.	Stone GW, Lindenfeld J, Abraham WT, et al. Transcatheter mitral-valve repair in patients with heart failure. N Engl J Med, 2018, 379(24): 2307-2318.
26.	Iung B, Armoiry X, Vahanian A, et al. Percutaneous repair or medical treatment for secondary mitral regurgitation: outcomes at 2 years. Eur J Heart Fail, 2019, 21(12): 1619-1627.
27.	Lim DS, Kar S, Spargias K, et al. Transcatheter valve repair for patients with mitral regurgitation: 30-day results of the CLASP study. JACC Cardiovasc Interv, 2019, 12(14): 1369-1378.
28.	Szerlip M, Spargias KS, Makkar R, et al. 2-year outcomes for transcatheter repair in patients with mitral regurgitation from the CLASP study. JACC Cardiovasc Interv, 2021, 14(14): 1538-1548.
29.	Schwartz CF, Gulkarov I, Bohmann K, et al. The role of annuloplasty in mitral valve repair. J Cardiovasc Surg (Torino), 2004, 45(5): 419-425.
30.	Nardi P, Pellegrino A, Olevano C, et al. Mitral valve repair for the treatment of degenerative mitral valve disease with or without prosthetic ring annuloplasty: long-term outcomes. J Cardiovasc Surg (Torino), 2013, 54(2): 305-312.
31.	Schofer J, Siminiak T, Haude M, et al. Percutaneous mitral annuloplasty for functional mitral regurgitation: results of the CARILLON mitral annuloplasty device European Union study. Circulation, 2009, 120(4): 326-333.
32.	Witte KK, Lipiecki J, Siminiak T, et al. The REDUCE FMR trial: a randomized sham-controlled study of percutaneous mitral annuloplasty in functional mitral regurgitation. JACC Heart Fail, 2019, 7(11): 945-955.
33.	Nickenig G, Schueler R, Dager A, et al. Treatment of chronic functional mitral valve regurgitation with a percutaneous annuloplasty system. J Am Coll Cardiol, 2016, 67(25): 2927-2936.
34.	Messika-Zeitoun D, Nickenig G, Latib A, et al. Transcatheter mitral valve repair for functional mitral regurgitation using the cardioband system: 1 year outcomes. Eur Heart J, 2019, 40(5): 466-472.
35.	Weber M, Öztürk C, Taramasso M, et al. Leaflet edge-to-edge treatment versus direct annuloplasty in patients with functional mitral regurgitation. EuroIntervention, 2019, 15(10): 912-918.
36.	Goode D, Dhaliwal R, Mohammadi H. Transcatheter mitral valve replacement: state of the art. Cardiovasc Eng Technol, 2020, 11(3): 229-253.
37.	Sorajja P, Moat N, Badhwar V, et al. Initial feasibility study of a new transcatheter mitral prosthesis: the first 100 patients. J Am Coll Cardiol, 2019, 73(11): 1250-1260.
38.	Grayburn PA, 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(2): 353-362.
39.	Kamoen V, Calle S, De Buyzere M, et al. Proportionate or disproportionate secondary mitral regurgitation: how to untangle the Gordian knot?. Heart, 2020, 106(22): 1719-1725.
40.	Hagendorff A, Knebel F, Helfen A, et al. Disproportionate mitral regurgitation: another myth? A critical appraisal of echocardiographic assessment of functional mitral regurgitation. Int J Cardiovasc Imaging, 2021, 37(1): 183-196.
41.	Gertz ZM, Raina A, Saghy L, et al. Evidence of atrial functional mitral regurgitation due to atrial fibrillation: reversal with arrhythmia control. J Am Coll Cardiol, 2011, 58(14): 1474-1481.
42.	Deferm S, Bertrand PB, Verhaert D, et al. Outcome and durability of mitral valve annuloplasty in atrial secondary mitral regurgitation. Heart, 2021, 107(18): 1503-1509.
43.	Schueler R, Momcilovic D, Weber M, et al. Acute changes of mitral valve geometry during interventional edge-to-edge repair with the MitraClip system are associated with midterm outcomes in patients with functional valve disease: preliminary results from a prospective single-center study. Circ Cardiovasc Interv, 2014, 7(3): 390-399.
44.	Colli A, Raanani E, Cobiella J, et al. Transapical and transfemoral combined mitral valve repair with annular and leaflet therapies. Ann Thorac Surg, 2020, 110(3): e221-e223.

1. Monteagudo Ruiz JM, Galderisi M, Buonauro A, et al. Overview of mitral regurgitation in Europe: results from the European Registry of mitral regurgitation (EuMiClip). Eur Heart J Cardiovasc Imaging, 2018, 19(5): 503-507.
2. Nkomo VT, Gardin JM, Skelton TN, et al. Burden of valvular heart diseases: a population-based study. Lancet, 2006, 368(9540): 1005-1011.
3. 叶蕴青, 许海燕, 李喆, 等. 中国不同区域老年瓣膜性心脏病构成和病因分析. 中华老年心脑血管病杂志, 2019, 21(7): 676-682.
4. Dziadzko V, Clavel MA, Dziadzko M, et al. Outcome and undertreatment of mitral regurgitation: a community cohort study. Lancet, 2018, 391(10124): 960-969.
5. Dziadzko V, Dziadzko M, Medina-Inojosa JR, et al. Causes and mechanisms of isolated mitral regurgitation in the community: clinical context and outcome. Eur Heart J, 2019, 40(27): 2194-2202.
6. Asgar AW, Mack MJ, Stone GW. Secondary mitral regurgitation in heart failure: pathophysiology, prognosis, and therapeutic considerations. J Am Coll Cardiol, 2015, 65(12): 1231-1248.
7. Nishimura RA, Otto CM, Bonow RO, et al. 2017 AHA/ACC focused update of the 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation, 2017, 135(25): e1159-e1195.
8. Bartko PE, Heitzinger G, Pavo N, et al. Burden, treatment use, and outcome of secondary mitral regurgitation across the spectrum of heart failure: observational cohort study. BMJ, 2021, 373: n1421.
9. Benfari G, Antoine C, Essayagh B, et al. Functional mitral regurgitation outcome and grading in heart failure with reduced ejection fraction. JACC Cardiovasc Imaging, 2021: S1936-878X(21)00437-X.
10. Otto CM, Nishimura RA, Bonow RO, et al. 2020 ACC/AHA guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol, 2021, 77(4): e25-e197.
11. Baumgartner H, Falk V, Bax JJ, et al. 2017 ESC/EACTS guidelines for the management of valvular heart disease. Eur Heart J, 2017, 38(36): 2739-2791.
12. Bonow RO, O’Gara PT, Adams DH, et al. 2020 focused update of the 2017 ACC expert consensus decision pathway on the management of mitral regurgitation: a report of the American College of Cardiology Solution Set Oversight Committee. J Am Coll Cardiol, 2020, 75(17): 2236-2270.
13. Maddox TM, Januzzi JL Jr, Allen LA, et al. 2021 update to the 2017 ACC expert consensus decision pathway for optimization of heart failure treatment: answers to 10 pivotal issues about heart failure with reduced ejection fraction: a report of the American College of Cardiology Solution Set Oversight Committee. J Am Coll Cardiol, 2021, 77(6): 772-810.
14. Yancy CW, Jessup M, Bozkurt B, et al. 2017 ACC/AHA/HFSA focused update of the 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology/American Heart Association Task Force on clinical practice guidelines and the heart failure society of America. Circulation, 2017, 136(6): e137-e161.
15. Chan KM, Punjabi PP, Flather M, et al. Coronary artery bypass surgery with or without mitral valve annuloplasty in moderate functional ischemic mitral regurgitation: final results of the randomized ischemic mitral evaluation (RIME) trial. Circulation, 2012, 126(21): 2502-2510.
16. Fattouch K, Guccione F, Sampognaro R, et al. POINT: efficacy of adding mitral valve restrictive annuloplasty to coronary artery bypass grafting in patients with moderate ischemic mitral valve regurgitation: a randomized trial. J Thorac Cardiovasc Surg, 2009, 138(2): 278-285.
17. Michler RE, Smith PK, Parides MK, et al. Two-year outcomes of surgical treatment of moderate ischemic mitral regurgitation. N Engl J Med, 2016, 374(20): 1932-1941.
18. Smith PK, Puskas JD, Ascheim DD, et al. Surgical treatment of moderate ischemic mitral regurgitation. N Engl J Med, 2014, 371(23): 2178-2188.
19. Alfieri O, Maisano F, De Bonis M, et al. The double-orifice technique in mitral valve repair: a simple solution for complex problems. J Thorac Cardiovasc Surg, 2001, 122(4): 674-681.
20. Maisano F, Caldarola A, Blasio A, et al. Midterm results of edge-to-edge mitral valve repair without annuloplasty. J Thorac Cardiovasc Surg, 2003, 126(6): 1987-1997.
21. Condado JA, Acquatella H, Rodriguez L, et al. Percutaneous edge-to-edge mitral valve repair: 2-year follow-up in the first human case. Catheter Cardiovasc Interv, 2006, 67(2): 323-325.
22. Feldman T, Wasserman HS, Herrmann HC, et al. Percutaneous mitral valve repair using the edge-to-edge technique: six-month results of the EVEREST phaseⅠclinical trial. J Am Coll Cardiol, 2005, 46(11): 2134-2140.
23. Whitlow PL, Feldman T, Pedersen WR, et al. Acute and 12-month results with catheter-based mitral valve leaflet repair: the EVERESTⅡ (endovascular valve edge-to-edge repair) high risk study. J Am Coll Cardiol, 2012, 59(2): 130-139.
24. Obadia JF, Messika-Zeitoun D, Leurent G, et al. Percutaneous repair or medical treatment for secondary mitral regurgitation. N Engl J Med, 2018, 379(24): 2297-2306.
25. Stone GW, Lindenfeld J, Abraham WT, et al. Transcatheter mitral-valve repair in patients with heart failure. N Engl J Med, 2018, 379(24): 2307-2318.
26. Iung B, Armoiry X, Vahanian A, et al. Percutaneous repair or medical treatment for secondary mitral regurgitation: outcomes at 2 years. Eur J Heart Fail, 2019, 21(12): 1619-1627.
27. Lim DS, Kar S, Spargias K, et al. Transcatheter valve repair for patients with mitral regurgitation: 30-day results of the CLASP study. JACC Cardiovasc Interv, 2019, 12(14): 1369-1378.
28. Szerlip M, Spargias KS, Makkar R, et al. 2-year outcomes for transcatheter repair in patients with mitral regurgitation from the CLASP study. JACC Cardiovasc Interv, 2021, 14(14): 1538-1548.
29. Schwartz CF, Gulkarov I, Bohmann K, et al. The role of annuloplasty in mitral valve repair. J Cardiovasc Surg (Torino), 2004, 45(5): 419-425.
30. Nardi P, Pellegrino A, Olevano C, et al. Mitral valve repair for the treatment of degenerative mitral valve disease with or without prosthetic ring annuloplasty: long-term outcomes. J Cardiovasc Surg (Torino), 2013, 54(2): 305-312.
31. Schofer J, Siminiak T, Haude M, et al. Percutaneous mitral annuloplasty for functional mitral regurgitation: results of the CARILLON mitral annuloplasty device European Union study. Circulation, 2009, 120(4): 326-333.
32. Witte KK, Lipiecki J, Siminiak T, et al. The REDUCE FMR trial: a randomized sham-controlled study of percutaneous mitral annuloplasty in functional mitral regurgitation. JACC Heart Fail, 2019, 7(11): 945-955.
33. Nickenig G, Schueler R, Dager A, et al. Treatment of chronic functional mitral valve regurgitation with a percutaneous annuloplasty system. J Am Coll Cardiol, 2016, 67(25): 2927-2936.
34. Messika-Zeitoun D, Nickenig G, Latib A, et al. Transcatheter mitral valve repair for functional mitral regurgitation using the cardioband system: 1 year outcomes. Eur Heart J, 2019, 40(5): 466-472.
35. Weber M, Öztürk C, Taramasso M, et al. Leaflet edge-to-edge treatment versus direct annuloplasty in patients with functional mitral regurgitation. EuroIntervention, 2019, 15(10): 912-918.
36. Goode D, Dhaliwal R, Mohammadi H. Transcatheter mitral valve replacement: state of the art. Cardiovasc Eng Technol, 2020, 11(3): 229-253.
37. Sorajja P, Moat N, Badhwar V, et al. Initial feasibility study of a new transcatheter mitral prosthesis: the first 100 patients. J Am Coll Cardiol, 2019, 73(11): 1250-1260.
38. Grayburn PA, 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(2): 353-362.
39. Kamoen V, Calle S, De Buyzere M, et al. Proportionate or disproportionate secondary mitral regurgitation: how to untangle the Gordian knot?. Heart, 2020, 106(22): 1719-1725.
40. Hagendorff A, Knebel F, Helfen A, et al. Disproportionate mitral regurgitation: another myth? A critical appraisal of echocardiographic assessment of functional mitral regurgitation. Int J Cardiovasc Imaging, 2021, 37(1): 183-196.
41. Gertz ZM, Raina A, Saghy L, et al. Evidence of atrial functional mitral regurgitation due to atrial fibrillation: reversal with arrhythmia control. J Am Coll Cardiol, 2011, 58(14): 1474-1481.
42. Deferm S, Bertrand PB, Verhaert D, et al. Outcome and durability of mitral valve annuloplasty in atrial secondary mitral regurgitation. Heart, 2021, 107(18): 1503-1509.
43. Schueler R, Momcilovic D, Weber M, et al. Acute changes of mitral valve geometry during interventional edge-to-edge repair with the MitraClip system are associated with midterm outcomes in patients with functional valve disease: preliminary results from a prospective single-center study. Circ Cardiovasc Interv, 2014, 7(3): 390-399.
44. Colli A, Raanani E, Cobiella J, et al. Transapical and transfemoral combined mitral valve repair with annular and leaflet therapies. Ann Thorac Surg, 2020, 110(3): e221-e223.

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