Percutaneous edge-to-edge leaflet repair: a solution to the risk–treatment paradox of mitral regurgitation complicated by pulmonary hypertension?

TY - JOUR

T1 - Percutaneous edge-to-edge leaflet repair

T2 - a solution to the risk–treatment paradox of mitral regurgitation complicated by pulmonary hypertension?

AU - Inohara, Taku

AU - Vemulapalli, Sreekanth

N1 - Funding Information: the authors appropriately note the following: (i) echocardiographic data regarding severity of MR and procedural success were not adjudicated by a core laboratory; (ii) pulmonary pressures were estimated using echocardiographic tricuspid regurgitation velocity rather than invasive measurement; (iii) RV function was not well assessed, making it difficult to differentiate the effects of RV function from those of pulmonary pressures; and (iv) no medical therapy control group was included.8 However, given that the majority of patients in the present study had functional MR, it is perhaps more problematic that, pending the results of the ongoing Cardiovascular Outcomes Assessment of MitraClip Percutaneous Therapy (COAPT) trial [NCT01626079], randomized data supporting the use of MitraClip or surgical therapy vs. medical therapy in functional MR are lacking. This lack of randomized data is responsible for the variation in recommendations for the treatment of functional MR between the ACC/AHA guidelines, which state that surgical intervention in functional MR should be limited to patients with moderate or severe MR undergoing other cardiac surgeries or patients with severe MR who remain symptomatic despite optimal medical therapy,3 and the ESC guidelines, which state that: ‘ … percutaneous edge-to-edge repair may be considered in order to improve symptoms and quality of life in patients with heart failure with moderate–severe, functional MR who are judged inoperable or at high surgical risk.’11 In the broader context of the risk–treatment paradox of MR complicated by PH, the findings of Tigges et al.8 are certainly encouraging and represent a necessary step towards finding a solution for these patients. However, considering the limitations of the data and previous discrepancies between observational data and randomized trials in cardiovascular disease,12 we may need to await randomized evidence of the efficacy of MitraClip treatment in functional MR before entertaining definitive efficacy in the PH subgroup. Conflict of interest: T.I. receives research support from the Japan Society for the Promotion of Science (JSPS) Overseas Research Fellowships. S.V receives research support from the American College of Cardiology, Abbott Vascular, the Society of Thoracic Surgeons and the Patient-Centered Outcomes Research Institute.

PY - 2018/3

Y1 - 2018/3

UR - http://www.scopus.com/inward/record.url?scp=85029218823&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85029218823&partnerID=8YFLogxK

U2 - 10.1002/ejhf.903

DO - 10.1002/ejhf.903

M3 - Editorial

C2 - 28891276

AN - SCOPUS:85029218823

SN - 1388-9842

VL - 20

SP - 595

EP - 597

JO - European Journal of Heart Failure

JF - European Journal of Heart Failure

IS - 3

ER -