Management of Secondary Mitral Regurgitation in Heart Failure: Multi society Joint statement
A joint team with members from ESC Heart Failure Association (HFA), European Association of Cardiovascular Imaging (EACVI), European Heart Rhythm Association (EHRA), and European Association of Percutaneous Cardiovascular Interventions (EAPCI), have proposed an updated practical approach to the management of patients with heart failure and secondary mitral regurgitation based on a multidisciplinary Heart Team approach. The statement has been published in European Heart Journal.
In the research report, the team has outlined the current evidence (and its limitations), discussed open issues that need to be addressed by future research, and stressed the importance of appropriate referral and selection of patients for transcatheter mitral valve intervention alongside guideline-recommended medical and device therapies.
The highlights of the statements have been summerised below.
- Secondary mitral regurgitation (SMR) is a common consequence of left ventricular remodelling and associated with adverse prognosis.Severity of SMR should be assessed by experienced echocardiographers using an integrated multi-parametric approach.
- Patients with symptomatic heart failure (HF) and moderate or severe SMR should be referred in a timely manner to a multidisciplinary Heart Team, including:Heart failure specialist,Cardiovascular imaging specialist,Interventional cardiologist with expertise in transcatheter mitral valve repair,Cardiac electrophysiologist,Cardiac surgeon with experience in mitral valve surgery.
- The Heart Team should first evaluate and optimize guideline-directed medical therapy (GDMT) and then consider the respective roles of device therapy (including cardiac resynchronization therapy, CRT), transcatheter mitral intervention and surgery (mitral repair, ventricular assist systems or transplantation), and their order of implementation.
- Decisions concerning treatments for mitral regurgitation, other than pharmacological therapy or circulatory support, should ideally be made in stable patients without fluid overload or the need for inotropic support.
- Surgical treatment of severe SMR should be considered in operable patients with coronary artery disease requiring surgical revascularization.
- Transcatheter edge-to-edge repair* is an evidence-based treatment option in patients with severe SMR who remain symptomatic despite GDMT (including CRT when indicated) and who have been carefully selected by a multidisciplinary Heart Team.
- Circulatory support devices and cardiac transplantation should be considered as an alternative in patients with advanced left and/or right ventricular failure.
- Interventions for mitral regurgitation should be avoided in patients with life expectancy <1 year due to conditions unrelated to the mitral regurgitation.
"Whilst international guidelines should be updated to reflect the findings of the recent randomized trials, further high-quality studies are required to refine selection criteria, explore indications beyond the current evidence base, and investigate the role of other transcatheter treatment options (annuloplasty, combined repair techniques, valve replacement)."the team concluded.
For full article follow the link: https://doi.org/10.1093/eurheartj/ehab086
Primary source:European Heart Journal