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Stolz et al. Mini-invasive Surg 2020;4:76 I http://dx.doi.org/10.20517/2574-1225.2020.69 Page 11 of 14

Since patients with PMR have severe structural pathologies of the MV, leaflet configuration seems to be
more important compared to SMR patients. Therefore, we recommend stricter separation of SMR and PMR
etiology within studies, as well as differentiating “sub-etiologies” of SMR (ischemic MR, non-ischemic
MR, ASMR, and HFmrEF-SMR), which could be done by multi-center pooling of data. A prerequisite is
comprehensive guideline-recommended echocardiographic assessments of cardiac anatomy and function,
also including the right heart and pulmonary vasculature. This integrated approach is challenging but
would facilitate further understanding of pathophysiology and outcome in a diversity of SMR subtypes
undergoing TMVr, thereby improving patient selection and procedural MR reduction to achieve optimal
outcome after TMVr.

DECLARATIONS
Authors’ contributions
Drafting of conceptual and methodologic framework: Stolz L, Orban M, Hausleiter J, Orban M
Manuscript writing: Stolz L, Orban M, Orban M
Manuscript review: Braun D, Nabauer M, Hagl C, Massberg S, Hausleiter J

Availability of data and materials
Not applicable.

Financial support and sponsorship
This work was supported by Klinikum der Universität München.

Conflicts of interest
Martin Orban has received speaker honoraria from SedanaMedical, AstraZeneca and Bayer Vital. Michael
Nabauer, Mathias Orban and Daniel Braun have received speaker honoraria from Abbott Vascular. Jörg
Hausleiter has received speaker honoraria from Abbott Vascular and Edwards Lifesciences. The other
authors declared that there are no conflicts of interest.

Ethical approval and consent to participate
Not applicable.

Consent for publication
Not applicable.

Copyright
© The Author(s) 2020.

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