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Cannata et al. Mini-invasive Surg 2020;4:53 I http://dx.doi.org/10.20517/2574-1225.2020.41 Page 15 of 17

and lastly mechanical circulatory supports (Impella and extracorporeal membrane oxygenation) are the
weapons to turn to [50,51] .

After the initial phases of echocardiographic diagnosis, hemodynamic stabilization, medical therapy
implementation and eventually percutaneous coronary revascularization, it is time for Heart Team
assessment. Interventionalists, cardiac surgeons, imagers, intensivists and heart failure specialists must
meet to tailor the best therapeutic pathway, weighing all clinical and anatomical factors: age, comorbidities,
hemodynamic status, response to medical therapy, MR mechanism, surgical risk, other surgical targets
and single centre’s experience. In cases of low surgical risk, presence of an indication for concomitant
cardiac surgery and organic MV disease, cardiac surgery is the first-choice treatment. Differently, in our
opinion, MitraClip should be always attempted in a stepwise approach, as it is a safe procedure and does
not preclude a delayed surgical intervention. Even in low-risk patients undergoing isolated MV surgery
with a low probability of surgical repair, MitraClip may be attempted, above all in high-volume centers.
Eligibility for percutaneous edge-to-edge procedure requires only three conditions: possibility to grasp and
[19]
approximate the leaflets, low risk of MV stenosis, and good-quality TEE imaging .

CONCLUSION
Acute MR is a life-threatening condition, traditionally treated as a medical and surgical emergency.
Percutaneous edge-to-edge repair of MV is a safe and effective therapeutic option, does not preclude
delayed cardiac surgery and is potentially able to solve almost any type of MV disease, with very few
contraindications. Echocardiographic identification of the precise valvular lesion and Heart Team
evaluation are pivotal to tailor the best therapeutic pathway for each patient. Literature confirms optimal
results of MitraClip in acute MR, but further studies are warranted to shed light on feasibility and
limitations of this powerful procedure.

DECLARATIONS
Authors’ contributions
Involved in clinical care: Sanz-Sánchez J, Chiarito M, Briani M, Fazzari F, Corrada E, Bragato RM, Pagnotta
PA, Regazzoli D
Wrote the manuscript: Cannata F, Regazzoli D
Supervised and coordinated all aspects of the research: Stefanini GG, Reimers B
Contributed to critical revision of the manuscript and approved the final version of the manuscript:
Cannata F, Sanz-Sánchez J, Chiarito M, Briani M, Fazzari F, Bertoldi LF, Ferrante G, Corrada E, Bragato
RM, Stefanini GG, Pagnotta PA, Reimers B, Regazzoli D

Availability of data and materials
Not applicable.

Financial support and sponsorship
None.

Conflicts of interest
All authors declared that there are no conflicts of interest.

Ethical approval and consent to participate
Not applicable.

Consent for publication
A written informed consent for publication was obtained.