Mitral regurgitation (MR) is the most frequent valve disease in the United States.1,2 Over 4 million people have significant MR, with an annual incidence of 250,000.1-3 Approximately 50,000 of these patients undergo surgery each year in the United States. Prevalence and incidence are similar in Europe, where it's the second most common type of heart valve disease.4
Mitral Regurgitation Is a Prevalent and Progressive Disease
MR is the second most common type of heart valve disease in Europe.4
If left untreated, MR initiates a cascade of events progressing to heart failure, then death.5,6
Degenerative MR, also called primary MR, is caused by damage to the mitral valve apparatus with prolapse or flail of the leaflets. It can be related to age, a birth defect, or underlying heart disease. Functional MR, also called secondary MR, is caused by enlargement of the heart due to heart attack or heart failure.
Approximately 50% of symptomatic patients with severe MR are not candidates for surgery due to underlying factors.* MR patients who most need intervention are often the most likely to be denied surgery.9
*Based on a survey of severely symptomatic MR patients in NYHA Class III-IV (n = 396); 10% had surgery the following year. The remainder had no surgery; medical management only.
Symptoms are usually those of heart failure: fatigue, dyspnea, orthopnea, edema, and palpitations—the final symptom often due to atrial fibrillation.
With left ventricular (LV) enlargement, there is an increase in pulmonary artery pressure and venous pressure, and eventually LV compensation fails.
Auscultation findings include:
- Notable S1
- S3 at the apex, indicating a dilated left ventricle and severe mitral regurgitation
The S3 often suggests a dilated left ventricle and progression to heart failure.
Patients with significant MR now have more options for effective treatment: not only surgical mitral valve replacement or repair, but transcatheter mitral valve repair (TMVr) as well.
For symptomatic patients diagnosed with moderate-severe or severe MR, surgery is generally recommended to repair or replace the mitral valve.4 This typically involves open-heart surgery with the patient on cardiopulmonary bypass. However, some patients are not eligible for repair or replacement based on surgical risk because of severe comorbidities or advanced age.4
According to the 2017 ESC/EACTS Guidelines, TMVr with MitraClip therapy may be considered for patients with symptomatic severe MR who are not suitable for surgery.4 Given the prevalence of MR, and the decreased long-term survival in medically managed patients, it’s important to consult established treatment guidelines and make intervention the standard of care for all appropriate patients.4,9
Robert Farivar, MDChief Thoracic Surgeon Minneapolis Heart Institute, Minnesota, USA
“There’s a large population of these patients that are not good surgical candidates. A lot of that age plays a role into, that increases our risk exponentially. One way to remove that risk is through a therapy like MitraClip.”
The information provided is not intended for medical diagnosis or treatment as a substitute for professional advice. Consult with a physician or qualified healthcare provider for appropriate medical advices.
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- Benjamin EJ, et al. Heart Disease and Stroke Statistics—2018 Update. A Report From the American Heart Association. Circulation. 2018;137:e67–e492. Doi: 10.1161/CIR.0000000000000558
- Nkomo VT, et al. Burden of valvular heart diseases: a population-based study. Lancet. 2006;368(9540):1005-1011.
- US Census Bureau. 2012-2016 American Community Survey Census Bureau 5-Year Estimates. factfinder.census.gov/faces/tableservices/jsf/pages/productview.xhtml. Accessed July 23, 2018.
- Baumgartner H, et al. 2017 ESC/EACTS Guidelines for the management of valvular heart disease: The Task Force for the Management of Valvular Heart Disease of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2017;38(21):2739-2791.
- Grigioni F, et al; MIDA Investigators. Outcomes in mitral regurgitation due to flail leaflets: a multicenter European study. JACC Cardiovasc Imaging. 2008;1(2):133-141.
- Enriquez-Sarano M, et al. Quantitative determinants of the outcome of asymptomatic mitral regurgitation. N Engl J Med. 2005;352(9):875-883
- Cioffi G, et al. Functional mitral regurgitation predicts 1-year mortality in elderly patients with systolic chronic heart failure. Eur J Heart Fail. 2005;7(7):1112-1117.
- Nishimura RA, et al. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2014;63(22):2438-2488.
- Mirabel M, et al. What are the characteristics of patients with severe, symptomatic, mitralregurgitation who are denied surgery? Eur Heart J. 2007;28(11):1358-1365.