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Degenerative mitral regurgitation

Nature Reviews Disease Primers volume 9, Article number: 70 (2023) Cite this article

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Abstract

Degenerative mitral regurgitation is a major threat to public health and affects at least 24 million people worldwide, with an estimated 0.88 million disability-adjusted life years and 34,000 deaths in 2019. Improving access to diagnostic testing and to timely curative therapies such as surgical mitral valve repair will improve the outcomes of many individuals. Imaging such as echocardiography and cardiac magnetic resonance allow accurate diagnosis and have provided new insights for a better definition of the most appropriate timing for intervention. Advances in surgical techniques allow minimally invasive treatment with durable results that last for ≥20 years. Transcatheter therapies can provide good results in select patients who are considered high risk for surgery and have a suitable anatomy; the durability of such repairs is up to 5 years. Translational science has provided new knowledge on the pathophysiology of degenerative mitral regurgitation and may pave the road to the development of medical therapies that could be used to halt the progression of the disease.

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Fig. 1: Types of degenerative mitral regurgitation.
Fig. 2: Structural changes in degenerative mitral regurgitation.
Fig. 3: Morphological features of the normal mitral valve and degenerative mitral valve disease.
Fig. 4: Mitral annulus abnormalities in degenerative mitral regurgitation.
Fig. 5: Management of patients with severe chronic primary mitral regurgitation.
Fig. 6: Transcatheter mitral valve repair techniques for primary mitral regurgitation.

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Authors and Affiliations

  1. University Hospital Germans Trias i Pujol, Badalona, Spain

    Victoria Delgado

  2. Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands

    Nina Ajmone Marsan

  3. Northwestern University Feinberg School of Medicine, Chicago, IL, USA

    Robert O. Bonow

  4. Columbia University Irving Medical Center, New York Presbyterian Hospital, New York, NY, USA

    Rebecca T. Hahn

  5. Department of Regenerative Medicine and Cell Biology, Medical University of South Carolina, Charleston, SC, USA

    Russell A. Norris

  6. South African Medical Research Council, Cape Town, South Africa

    Liesl Zühlke

  7. Division of Paediatric Cardiology, Department of Paediatrics, Institute of Child Health, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa

    Liesl Zühlke

  8. University Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany

    Michael A. Borger

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V.D. and M.A.B. defined the outline of the review and performed the literature search. All the authors contributed to the drafting of the manuscript, reviewed the compiled version, provided constructive feedback and suggestions for improvement and approved the final version for submission. Overview of Primer: V.D.

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Correspondence to Victoria Delgado.

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V.D. received speaker fees from Edwards Lifesciences (aortic valve disease), Medtronic (aortic valve disease), Novartis (heart failure) and Philips (echocardiography), and consulting fees from Edwards Lifesciences (tricuspid valve disease) and Novo Nordisk (heart failure). M.A.B. declares that his hospital receives speakers’ honoraria and/or consulting fees on his behalf from Edwards Lifesciences, Medtronic, Abbott and Artivion. N.A.M. received speaker fees from Abbott Vascular, Philips Ultrasound, GE Healthcare and Ormon, and research grants from Pfizer, Novartis, Alnylam and Pie Medical. R.T.H. reports speaker fees from Abbott Structural, Baylis Medical, Edwards Lifesciences, Medtronic and Philips Healthcare; she has institutional consulting contracts for which she receives no direct compensation with Abbott Structural, Edwards Lifesciences, Medtronic and Novartis; she is Chief Scientific Officer for the Echocardiography Core Laboratory at the Cardiovascular Research Foundation for multiple industry-sponsored tricuspid valve trials, for which she receives no direct industry compensation. R.A.N. reports funding from the National Institutes of Health (grant number C06 RR018823, from the Extramural Research Facilities Program of the National Center for Research Resources). Other funding sources: National Institutes of Health (GM103444, R.A.N.; HL149696, R.A.N.; HL131546, R.A.N.). L.Z. is funded by the South African Medical Research Council (SAMRC) through its Division of Research Capacity Development under the Mid-Career Scientist Programme from funding received from the South African National Treasury. The contents hereof are the sole responsibility of the authors and do not necessarily represent the official views of the SAMRC. L.Z. also receives support from the National Research Foundation of South Africa (NRFSA), as well as the UK Medical Research Council (MRC) and the UK Department for International Development (DFID) under the MRC/DFID Concordat agreement, via the African Research Leader Award (MR/S005242/1). R.O.B. declares no competing interests.

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Nature Reviews Disease Primers thanks S. Maréchaux, V. Rudolph and Y. Topilsky for their contribution to the peer review of this work.

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41572_2023_478_MOESM1_ESM.mp4

Supplementary Video 1 Minimally invasive surgical repair of mitral valve prolapse. The valve exposure and the steps to achieve a successful mitral valve repair with minimally invasive surgery are shown.

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Delgado, V., Ajmone Marsan, N., Bonow, R.O. et al. Degenerative mitral regurgitation. Nat Rev Dis Primers 9, 70 (2023). https://doi.org/10.1038/s41572-023-00478-7

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