Decision-Making in Transcatheter Edge-to-Edge Repair: Insights into Atrial Functional Mitral Regurgitation

The 2020 American College of Cardiology focused update on the mitral regurgitation (MR) pathway provides an excellent summary of the decision-making trees in the treatment of severe MR, in which 2 main branches of the flowchart are suggested depending on whether MR is primary or secondary. Surgery i...

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Autor principal:	Joon Bum Kim
Formato:	article
Lenguaje:	EN
Publicado:	Korean Society for Thoracic & Cardiovascular Surgery 2021
Materias:	transcatheter edge-to-edge repair mitraclip mitral repair surgery atrial functional mitral regurgitation Medicine (General) R5-920
Acceso en línea:	https://doaj.org/article/a462c3d4e8f7422190eebacda4e61b02
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spelling	oai:doaj.org-article:a462c3d4e8f7422190eebacda4e61b022021-12-03T01:14:15ZDecision-Making in Transcatheter Edge-to-Edge Repair: Insights into Atrial Functional Mitral Regurgitation10.5090/jcs.21.0682765-16062765-1614https://doaj.org/article/a462c3d4e8f7422190eebacda4e61b022021-12-01T00:00:00Zhttps://doaj.org/toc/2765-1606https://doaj.org/toc/2765-1614The 2020 American College of Cardiology focused update on the mitral regurgitation (MR) pathway provides an excellent summary of the decision-making trees in the treatment of severe MR, in which 2 main branches of the flowchart are suggested depending on whether MR is primary or secondary. Surgery is suggested as preferable over transcatheter edge-to-edge repair (TEER) in primary MR that needs intervention. The decision-making for secondary MR generally prioritizes TEER over surgery according to the guidelines, but further stratification is necessary based on the pathophysiologic mechanisms of MR. TEER is probably the more suitable option in secondary MR caused by left ventricular dysfunction or dilatation, given the high perceived surgical risks, despite the lack of sufficient evidence in support of overt clinical benefits from surgical therapy in these patients. In atrial functional MR associated with atrial fibrillation (AF), however, concomitant ablation of AF seems to be a desirable option, as it has been demonstrated to be a key factor leading to improved survival, reduced stroke risk, and more durable mitral and tricuspid function in patients undergoing mitral surgery. Therefore, atrial functional MR requiring intervention may be best treated by surgical therapy that combines mitral repair and AF ablation in the majority of patients. This particular issue, however, needs further research to obtain scientific evidence to guide optimal management strategies.Joon Bum KimKorean Society for Thoracic & Cardiovascular Surgeryarticletranscatheter edge-to-edge repairmitraclipmitral repairsurgeryatrial functional mitral regurgitationMedicine (General)R5-920ENJournal of Chest Surgery, Vol 54, Iss 6, Pp 449-453 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	transcatheter edge-to-edge repair mitraclip mitral repair surgery atrial functional mitral regurgitation Medicine (General) R5-920
spellingShingle	transcatheter edge-to-edge repair mitraclip mitral repair surgery atrial functional mitral regurgitation Medicine (General) R5-920 Joon Bum Kim Decision-Making in Transcatheter Edge-to-Edge Repair: Insights into Atrial Functional Mitral Regurgitation
description	The 2020 American College of Cardiology focused update on the mitral regurgitation (MR) pathway provides an excellent summary of the decision-making trees in the treatment of severe MR, in which 2 main branches of the flowchart are suggested depending on whether MR is primary or secondary. Surgery is suggested as preferable over transcatheter edge-to-edge repair (TEER) in primary MR that needs intervention. The decision-making for secondary MR generally prioritizes TEER over surgery according to the guidelines, but further stratification is necessary based on the pathophysiologic mechanisms of MR. TEER is probably the more suitable option in secondary MR caused by left ventricular dysfunction or dilatation, given the high perceived surgical risks, despite the lack of sufficient evidence in support of overt clinical benefits from surgical therapy in these patients. In atrial functional MR associated with atrial fibrillation (AF), however, concomitant ablation of AF seems to be a desirable option, as it has been demonstrated to be a key factor leading to improved survival, reduced stroke risk, and more durable mitral and tricuspid function in patients undergoing mitral surgery. Therefore, atrial functional MR requiring intervention may be best treated by surgical therapy that combines mitral repair and AF ablation in the majority of patients. This particular issue, however, needs further research to obtain scientific evidence to guide optimal management strategies.
format	article
author	Joon Bum Kim
author_facet	Joon Bum Kim
author_sort	Joon Bum Kim
title	Decision-Making in Transcatheter Edge-to-Edge Repair: Insights into Atrial Functional Mitral Regurgitation
title_short	Decision-Making in Transcatheter Edge-to-Edge Repair: Insights into Atrial Functional Mitral Regurgitation
title_full	Decision-Making in Transcatheter Edge-to-Edge Repair: Insights into Atrial Functional Mitral Regurgitation
title_fullStr	Decision-Making in Transcatheter Edge-to-Edge Repair: Insights into Atrial Functional Mitral Regurgitation
title_full_unstemmed	Decision-Making in Transcatheter Edge-to-Edge Repair: Insights into Atrial Functional Mitral Regurgitation
title_sort	decision-making in transcatheter edge-to-edge repair: insights into atrial functional mitral regurgitation
publisher	Korean Society for Thoracic & Cardiovascular Surgery
publishDate	2021
url	https://doaj.org/article/a462c3d4e8f7422190eebacda4e61b02
work_keys_str_mv	AT joonbumkim decisionmakingintranscatheteredgetoedgerepairinsightsintoatrialfunctionalmitralregurgitation
_version_	1718374006434824192

Decision-Making in Transcatheter Edge-to-Edge Repair: Insights into Atrial Functional Mitral Regurgitation

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