Reverse Remodeling in the Perspective of Decision Making for Mitral Valve Repair With the MitraClip
Degenerative and functional mitral regurgitation (MR) constitute 2 separate disease entities. Although the pathophysiological problem is directly addressed by a successful intervention on the valve in the first case, the underlying ventricular disease persists in the latter.
Article see p 1667
Indications for surgery in MR are well defined for degenerative MR, in which relief of the valve lesion leads to relief of left ventricular volume overload. The timing of surgery is based on symptoms, left ventricular size and function, atrial fibrillation, and pulmonary hypertension.1,2 When following these criteria, surgery is associated with symptomatic improvement and a survival benefit. Nevertheless, up to 50% of patients, particularly the elderly and those who present with comorbidities or reduced ventricular function, are denied surgery despite having a clear indication for intervention.3
Criteria for surgical intervention are less well defined in functional MR, in which the valve is structurally normal and regurgitation is caused by an imbalance between closing and tethering forces related to a ventricular pathology4 that is not entirely corrected by the relief of MR. From surgical experience, it is known that valve intervention leads to an initial reduction of MR, although the recurrence rate is high and a survival benefit has not been demonstrated so far.5 Furthermore, the surgical …