From the Guidelines
The treatment for mitral regurgitation (mitral valve insufficiency) should prioritize surgical repair or replacement of the mitral valve for symptomatic or severe cases, with a preference for repair when possible, as recommended by the most recent guidelines 1.
Treatment Approach
The approach to treating mitral regurgitation depends on the severity, cause, and symptoms of the condition. For primary mitral regurgitation, surgical intervention is recommended for symptomatic patients with severe regurgitation, regardless of left ventricular (LV) function, as well as for asymptomatic patients with LV dysfunction, defined as an LV ejection fraction (LVEF) <60% and/or an LV end-systolic dimension (LVESD) >40 mm 1.
Medical Therapy
Medical therapy plays a crucial role in managing symptoms and slowing disease progression. This includes:
- Diuretics, such as furosemide, to reduce fluid overload and symptoms of heart failure
- ACE inhibitors, like enalapril or lisinopril, to reduce afterload
- Beta-blockers, such as metoprolol, to control heart rate and reduce workload on the heart
Transcatheter Mitral Valve Repair
For patients with severe primary mitral regurgitation who are at high or prohibitive risk for surgery, transcatheter edge-to-edge repair (TEER) may be considered as an alternative to surgical intervention, as indicated by recent guidelines and studies 1.
Secondary Mitral Regurgitation
The best therapy for chronic secondary mitral regurgitation is not clear, but guidelines suggest that mitral valve surgery or intervention should only be considered in patients who remain symptomatic despite optimal guideline-directed medical therapy (GDMT) 1.
Recent Evidence
Recent studies, such as the COAPT trial, have demonstrated the benefit of transcatheter mitral valve repair in reducing hospitalizations and mortality in patients with heart failure and severe secondary mitral regurgitation who are on optimal medical therapy 1.
Key Considerations
The timing of intervention is critical, as waiting too long can lead to irreversible heart damage, while intervening too early exposes patients to unnecessary surgical risks. Regular follow-up with a cardiologist is essential to monitor disease progression and optimize treatment.
From the Research
Treatment Options for Mitral Regurgitation
The treatment for mitral regurgitation (mitral valve insufficiency) can vary depending on the severity and cause of the condition. Some of the treatment options include:
- Surgical intervention, such as mitral valve repair or replacement, which is often recommended for patients with severe mitral regurgitation 2, 3
- Transcatheter mitral valve replacement, which is a minimally invasive procedure that can be used to treat patients with severe mitral regurgitation who are not suitable candidates for surgery 4
- Medical treatment, such as the use of ACE inhibitors and angiotensin receptor blockers (ACE-I/ARB), which can help to improve clinical outcomes in patients with moderate to severe mitral regurgitation 5
- Percutaneous valve interventions, which are a relatively new development in the treatment of mitral regurgitation and have shown promising results in initial studies 2, 6
Considerations for Treatment
When considering treatment for mitral regurgitation, several factors need to be taken into account, including:
- The severity of the mitral regurgitation, which can be assessed using quantitative measures such as echocardiography 2, 6
- The cause of the mitral regurgitation, which can be either primary (organic) or secondary (functional) 2
- The presence of any underlying medical conditions, such as heart failure or atrial fibrillation, which can affect treatment outcomes 4, 5
- The patient's overall health and suitability for surgical or transcatheter intervention, which can be assessed using tools such as the Society of Thoracic Surgeons Predicted Risk of Mortality score 4