Case Study Revisited
Our 70-year-old patient presents with Stage D severe, chronic degenerative MR. She has a class I indication for mitral valve repair. Although evidence is promising, it remains limited and surgical repair should be offered first to our patient. However, she would likely fall in the high-risk stratification of MR repair patients and may refuse surgical intervention. Analysis of her anatomy should be performed and she should be medically optimized. If she is deemed high risk and her anatomy is favorable, it would be reasonable to refer her to a Valve Center of Excellence experienced in the MitraClip therapy for percutaneous repair.
Mitral regurgitation is a common valvular disorder with a well-described, progressive morbidity and mortality. Surgical repair has delivered significantly improved outcomes; however, many patients with MR, particularly with an aging population with increasing MR prevalence, are poor surgical candidates. Transcatheter MV repair, as described above with the MitraClip, has shown significant promise in delivering similar outcomes with a satisfactory safety profile. Although currently only approved by the FDA for stage D degenerative MR repair in the United States, observational studies in Europe have shown similar levels of evidence with percutaneous repair of functional MR, including cases with advanced or refractory HF. Consequently, indications may soon expand with further long-term and expanded-use studies.
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