MitraClip for secondary mitral regurgitation: Patient selection

Mitral regurgitation (MR) is one of the common valvular heart diseases and can be broadly categorized as primary or secondary. Primary MR occurs due to abnormalities of the valvular apparatus where surgical repair offers excellent outcomes. In contrast, the underlying degree of left ventricular dysfunction plays a major role in the development of secondary MR. Recently, two randomized controlled trials, the Percutaneous Repair with the MitraClip Device for Severe Functional/ Secondary Mitral Regurgitation (MITRA-FR) and the Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients with Functional Mitral Regurgitation (COAPT), evaluated the role of transcatheter edge-to-edge repair (TEER) using MitraClip device among heart failure patients with secondary MR and observed contradictory results; this has created a considerable dilemma among clinicians for an appropriate patient selection for the transcatheter mitral valve (MV) therapies. In this review, we highlight several important differences in patient characteristics between the COAPT and MITRA-FR trials that may help explain the differences observed in outcomes. We also reviewed several key clinical, echocardiographic, and procedural characteristics that may guide clinicians in improving patient selection for transcatheter MV therapies for better outcomes.