Arq. Bras. Cardiol. 2021; 116(5): 1011-1018
Percutaneous Treatment of Secondary Mitral Regurgitation by MitraClip: Mitra-FR vs. COAPT
Sergio Barros-Gomes
, Flávio Tarasoutchi
, Ana Clara Tude Rodrigues, Lara Ferreira Nhola, Pedro Alves Lemos, Samira Saady Morhy, Claudio Henrique Fischer, Marcelo Luiz Campos Vieira
Introduction
Secondary or functional mitral regurgitation (MR) is due to changes in the geometry of the left ventricle (LV) secondary to ventricular dysfunction. It occurs when an ischemic heart disease or a dilated cardiomyopathy of any etiology causes dilation of the LV, dilation of the mitral ring, and/or displacement of the papillary muscle, resulting in poor coaptation of the valve cusps and valve regurgitation. the American Heart Association indicates that 16,250 per million North Americans have secondary MR,, totaling more than 5 million cases in the United States of America alone, and this number is estimated to be even greater due to the continued growth and aging of the population. This is noteworthy, as secondary MR causes a poor prognosis and is an independent predictor of mortality.,
For many years, the mechanical intervention of secondary MR (surgical or percutaneous) has been restricted to cases refractory to conventional clinical treatment,, with evidence mainly supported by two important studies conducted by the Cardiothoracic Surgical Trials Network group., The first study randomized 301 patients with moderate ischemic MR and found no differences in ventricular geometry between patients who undergone surgical myocardial revascularization versus the combination of surgical revascularization and mitral valve repair. The second study surveyed 251 patients with severe MR and found no differences regarding mortality, in addition to the greater recurrence of mitral regurgitation and complication rates among patients treated with mitral valve repair versus valve replacement. Considering these two studies, the recommendations of the American Heart Association/American College of Cardiology and the Brazilian Guidelines for Valvular Heart Disease classified surgical or percutaneous mitral valve intervention as a Class IIb indication.
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