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Patient selection for percutaneous mitral valve repair: insight from early clinical trial applications

Nature Clinical Practice Cardiovascular Medicine volume 5, pages 84–90 (2008)Cite this article

Abstract

Surgical valve repair for mitral regurgitation (MR) has been used for decades. Percutaneous approaches to mitral valve repair have been undergoing evaluation in trials over the last few years, and could offer less-invasive alternatives to surgery for the treatment of MR. Patient selection for surgical repair has been defined not only by the pathophysiology of MR, but also by the likelihood of successful repair for degenerative compared with functional MR. Patients with degenerative MR have excellent acute and long-term results following surgical repair; the acute risks of surgery in patients with heart failure are high in comparison, and late recurrent MR has been problematic after surgical repair for ischemic MR. Patient selection for percutaneous approaches to MR will be influenced by both the underlying valve pathology and the expected outcomes in various patient subsets, and also by the characteristics of the various percutaneous devices. This Review examines the established selection criteria for surgical repair and discusses the potential impact of new percutaneous approaches.

Key Points

  • Patient selection for surgical repair for mitral regurgitation has been described in guidelines; an understanding of surgical results is necessary to understand the potential for percutaneous therapies for mitral regurgitation

  • New percutaneous methods for mitral repair are developing rapidly, and include coronary sinus annuloplasty, direct annuloplasty, leaflet repair and chamber remodeling

  • Patients suitable for these less-invasive therapies could include some patients typically treated with surgery, certain patients with contraindications to surgery, and those who are currently not considered for surgery because of low risk disease or those for whom the benefits of surgery are unclear

  • Percutaneous devices for mitral regurgitation are currently all experimental, but developing rapidly

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Bruce C. V. Campbell, Deidre A. De Silva, … Geoffrey A. Donnan

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Authors and Affiliations

  1. and D Glower is Professor at the Department of Surgery, T Feldman is Director of the Cardiac Catheterization Laboratory at Evanston Northwestern Healthcare, and Professor of Medicine at the Northwestern University Medical School, Evanston, IL, Duke University Medical Center, Durham, NC, USA.,

    Ted Feldman & Donald Glower

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  1. Ted Feldman
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  2. Donald Glower
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Correspondence to Ted Feldman.

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Competing interests

T Feldman has received grant support from the following companies: Abbott, Atritech, BSC, Cardiac Dimensions, Cordis, Edwards Lifesciences, Evalve, EV3 and St Jude. He is a consultant for Cardiac Dimensions, Cordis and Myocor, and a speaker for Boston Scientific.

D Glower has received grant/research support from Edwards Lifesciences and Evalve.

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Feldman, T., Glower, D. Patient selection for percutaneous mitral valve repair: insight from early clinical trial applications. Nat Rev Cardiol 5, 84–90 (2008). https://doi.org/10.1038/ncpcardio1068

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