Excerpt

Severe secondary mitral regurgitation (MR) affects about one of four patients with heart failure and reduced ejection fraction (HFrEF) and is associated with a twofold increase in mortality and heart failure hospitalization [1]. Evidence-based medical and device [cardiac resynchronization (CRT)] therapy improves outcome in HFrEF patients, contributes to reverse remodeling and improvement of MR and hence is the gold-standard for treatment of secondary MR in current guidelines [2]. Until now, evidence was lacking on whether specific treatment of secondary MR, i.e., surgical or interventional valve repair or replacement, can impact the course of HFrEF and patient outcome. Accordingly, current guidelines give only a low class of recommendation for isolated surgical or interventional treatment of secondary MR for patients who are symptomatic despite optimal HFrEF therapy [2, 3]. MITRA-FR and COAPT are the first randomized controlled trials to examine repair of secondary MR using the percutaneous MitraClip technique in patients with symptomatic HFrEF in addition to the gold-standard of guideline-directed medical and device therapy [4, 5]. …