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Pal et al. Vessel Plus 2019;3:39 Vessel Plus
DOI: 10.20517/2574-1209.2019.24

Commentary Open Access

Percutaneous edge-to-edge mitral valve repair for
secondary mitral regurgitation: perspectives on

COAPT and MITRA-FR trials

Nirvik Pal, Mark Nelson, John Butterworth

Department of Anesthesiology, Virginia Commonwealth University, Virginia, VA 23298-0541, USA.
Correspondence to: Nirvik Pal, Assistant Professor in Anesthesiology, Division of Cardiothoracic Anesthesiology, Departmen of
Anesthesiology, 1250 East Marshall St, 5th Floor, PO Box 980541, Richmond, Virginia, VA 23298-0541, USA.
E-mail: nirvik.pal@vcuhealth.org

How to cite this article: Pal N, Nelson M, Butterworth J. Percutaneous edge-to-edge mitral valve repair for secondary mitral
regurgitation: perspectives on COAPT and MITRA-FR trials. Vessel Plus 2019;3:39. http://dx.doi.org/10.20517/2574-1209.2019.24
Received: 17 Jul 2019 First Decision: 22 Aug 2019 Revised: 20 Sep 2019 Accepted: 24 Sep 2019 Published: 12 Dec 2019

Science Editor: Mario F. L. Gaudino Copy Editor: Jing-Wen Zhang Production Editor: Jing Yu

Received: First Decision: Revised: Accepted: Published: x
Mitral valve regurgitation (MR) is classified as primary or secondary depending upon pathophysiology.
Science Editor: Copy Editor: Production Editor: Jing Yu Primary MR arises from degenerative disease of the valve leaflets whereas secondary MR is due to
[1]
dilatation of left ventricle leading to distortion of valve architecture . Therapy for primary MR is
[2,3]
established: valve repair (surgery or percutaneous), or valve replacement when repair is not possible .
[4]
In contrast, therapy for secondary MR is still a matter of debate . It is universally agreed that treatment
for left ventricular dilatation is foremost by guideline directed medical therapy (GDMT) and cardiac
[3]
resynchronization therapy . Whether to treat the MR mechanically constitutes the dilemma. This
intriguing conundrum becomes even more interesting with publication of two similar trials with opposite
[5,6]
results . If reproducibility is the foundation of settled new knowledge, then why did these two large
randomized controlled trials have seemingly irreconcilable results?

Investigators of the COAPT (Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy
for Heart Failure Patients with Functional Mitral Regurgitation, USA) and the MITRA-FR (Percutaneous
[6]
[5]
Repair with the MitraClip Device for Severe Functional/Secondary Mitral Regurgitation, France) trials
hoped to seek whether secondary MR was simply a marker of a diseased and dilated left ventricle or
separately contributed to patient mortality and therapy via edge-to-edge percutaneous repair of mitral
@
valve (MV) (MitraClip ) would be efficacious. Incidentally, results of the MITRA-FR trial support the
former assertion while those of COAPT trial seem to corroborate the later.

© The Author(s) 2019. 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
as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license,
and indicate if changes were made.

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