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Masiero et al. Mini-invasive Surg 2020;4:71 Mini-invasive Surgery
DOI: 10.20517/2574-1225.2020.56

Review Open Access

Percutaneous “edge-to-edge” leaflet repair in
patients with secondary mitral valve regurgitation

Giulia Masiero, Giulio Rodinò, Giuseppe Tarantini

Department of Cardiac, Thoracic, Vascular Science and Public Health, University of Padova, Padova 35128, Italy.
Correspondence to: Dr. Giuseppe Tarantini, Department of Cardiac, Thoracic and Vascular Science, University of Padova, Via
Giustiniani 2, Padova 35128, Italy. E-mail: giuseppe.tarantini.1@gmail.com

How to cite this article: Masiero G, Rodinò G, Tarantini G. Percutaneous “edge-to-edge” leaflet repair in patients with secondary
mitral valve regurgitation. Mini-invasive Surg 2020;4:71. http://dx.doi.org/10.20517/2574-1225.2020.56

Received: 8 Jun 2020 First Decision: 15 Jul 2020 Revised: 5 Aug 2020 Accepted: 18 Aug 2020 Published: 16 Oct 2020

Academic Editor: Azeem Latib Copy Editor: Cai-Hong Wang Production Editor: Jing Yu

Abstract
Functional or secondary mitral regurgitation (MR) is a heterogeneous entity afflicting patients with heart failure
both with reduced or preserved left ventricular ejection fraction. It results from an imbalance between closing
forces and tethering or pushing strengths acting on the valve in the absence of structural alterations of mitral valve
(MV) apparatus. According to previous studies, more than 20% of patients with heart failure and reduced left
ventricular ejection fraction have severe MR, even though the definition of the severity of the MV disease in this
setting remains a debated issue due to the poor reproducibility of quantitative measurements and its dynamic
nature, highly dependent on left ventricular loading conditions and performance in relation to optimization of
medical treatment. Furthermore, it is still unclear whether MR is a direct contributor to a worse prognosis or
merely a marker of severity of the disease affecting the left ventricle. Isolated MV surgery in these patients is
burdened by significant operative mortality, high rates of recurrent MR and absence of proven survival benefit.
In recent years, percutaneous treatment of functional MR arose as a viable and safe alternative to conventional
surgery, proving capable of reducing symptoms and recurrent hospitalization rates for heart failure, and even
improving prognosis in selected patients. In this review we will discuss the percutaneous treatment of functional
MR through transcatheter “edge-to-edge” leaflet repair performed with the two systems currently available: the
MitraClip System and the PASCAL Repair System, from available evidence to technical practice.

Keywords: Functional mitral valve disease, mitral regurgitation, mitral insufficiency, heart failure, MitraClip,
PASCAL

© 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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