Reverse Remodeling in the Perspective of Decision-Making for Mitral Valve Repair with the MitraClip
Degenerative and functional mitral regurgitation (MR) constitute two separate disease entities: while 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.
Indications for surgery in mitral regurgitation are well defined for degenerative MR, where the relief of the valve lesion leads to a relief on the left ventricular volume overload. The timing of surgery is based on symptoms, left ventricular size and function, atrial fibrillation and pulmonary hypertension1, 2. When following these criteria, surgery is associated with symptomatic improvement and also with a survival benefit. Nevertheless, up to 50% of patients, in particular when they are elderly or present with comorbidities or reduced ventricular function are denied surgery despite having a clear indication for intervention3.
- Received August 28, 2013.
- Accepted September 3, 2013.