European Journal of Heart Failure expert consensus statement on transcatheter treatment of mitral regurgitation in heart failure

Secondary mitral regurgitation (SMR) is highly prevalent in patients with heart failure (HF), associated with poor prognosis, and its treatment is typically preceded by implementing pharmacotherapy for HF as well as cardiac resynchronization therapy. Given the increase in experience and important technological iterations, transcatheter mitral valve repair has witnessed increasing safety and efficacy. Recently, two randomized controlled trials extended the level of evidence for this intervention in patients with SMR: RESHAPE-HF2 randomized patients with less severe SMR to either medical therapy alone versus adjunct transcatheter repair, whereas the MATTERHORN trial compared surgical therapy with transcatheter mitral valve repair in patients with SMR and increased risk for surgery. These two trials have a potential impact on the indications of transcatheter repair. Here we discuss updated indications for transcatheter mitral valve therapy across the different subtypes of SMR, revisit the current body of evidence for transcatheter mitral valve repair and classify this technique into the current treatment hierarchy of SMR in patients with HF.