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Scotti et al . Mini-invasive Surg 2020;4:49 Mini-invasive Surgery
DOI: 10.20517/2574-1225.2020.38

Review Open Access

Percutaneous mitral valve repair in patients with
secondary mitral regurgitation and advanced heart
failure

Andrea Scotti , Alberto Margonato , Cosmo Godino 2
2
1
1 Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padua Medical School, Padua 35128, Italy.
2 Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan 20132, Italy.
Correspondence to: Dr. Cosmo Godino, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Via Olgettina
60, Milan 20132, Italy. E-mail: godino.cosmo@hsr.it
How to cite this article: Scotti A, Margonato A, Godino C. Percutaneous mitral valve repair in patients with secondary mitral
regurgitation and advanced heart failure. Mini-invasive Surg 2020;4:49. http://dx.doi.org/10.20517/2574-1225.2020.38

Received: 19 Apr 2020 First Decision: 18 Jun 2020 Revised: 23 Jun 2020 Accepted: 6 Jul 2020 Published: 7 Aug 2020
Academic Editor: Giulio Belli Copy Editor: Cai-Hong Wang Production Editor: Tian Zhang

Abstract
Advanced heart failure (HF) prevalence is increasing and ranges between 1% and 10% of the overall HF population,
due to the growing number of patients with HF and their better treatment and survival in the last 20 years. The
best treatment for these patients is represented by heart transplantation, which, unfortunately, is only available for
a minority of them. A significant portion of patients with advanced HF has concomitant severe mitral regurgitation,
which acts as a driving force in inducing and maintaining this end-stage condition in a vicious cycle. Percutaneous
mitral valve repair with MitraClip is a treatment option to stop this vicious cycle, providing safer outcomes and
clinical benefits in some of these patients. Preliminary clinical observations show a possible selective role for
percutaneous mitral valve treatment with MitraClip as a bridge to transplantation, candidacy or recovery. Further
evidence will be necessary to confirm these preliminary data and support this new treatment framework of
patients with advanced HF.

Keywords: Mitral regurgitation, secondary mitral regurgitation, percutaneous mitral valve repair, advanced heart
failure, heart transplantation, bridge therapy

INTRODUCTION
Mitral regurgitation (MR) is the most common valve disease worldwide, affecting at least 20% of patients
aged > 65 years . Secondary MR (SMR) is the predominant and most clinically relevant form. Indeed,
[1]
[2]
SMR, even when mild, correlates with higher adverse outcomes . While the ischemic vs. non-ischemic
etiologies do not impact on these findings , higher grades of SMR severity are associated with reduced
[3]
© The Author(s) 2020. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use,
sharing, adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as long
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