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Let’s turn the page on mitral regurgitation

For too long, mitral regurgitation (MR) has been undertreated, compromising patient outcomes. It's 
time to deliver targeted and effective treatments for moderate-to-severe and severe MR  that improve cardiac function and change lives.1–4

Understanding MR helps ensure that your patients get the right treatment

MR is backward blood flow during left ventricular systole, which can lead to progressive symptoms if left untreated. Structural changes to the heart can lead to atrial fibrillation, heart failure (HF) and pulmonary hypertension.5,6

MR is characterised by two distinct aetiologies:

Degenerative MR (DMR) 1
Degenerative MR (DMR) 2

Degenerative MR (DMR)

Any MR resulting from structural deformity or damage to the leaflets, chordae or papillary muscles, causing leaflets to close insufficiently during systole.7–10 DMR affects 2% of the population11 and 24.2 million people worldwide.12

The most common cause of DMR is mitral valve prolapse, which is defined by a spectrum of lesions.11

most common cause of DMR SVG

Functional MR (FMR)

Any MR resulting from left ventricle or left atrium abnormalities/disease. There are no structural problems with the valve apparatus itself.9,10 Significant FMR has been shown to develop in around half of patients with myocardial infarction and up to 50% of patients with HF.13

Isolated moderate or severe MR is associated with reduced survival and often goes untreated2,14,15

2% most common form VHD

MR is the most common form of valvular heart disease (VHD) in the developed world, affecting 2% of people worldwide.3,10,14

VHD 19M of europe adults

MR is the second most common VHD in Europe, affecting >19 million adults >65 years old, as extrapolated from a community study in Oxfordshire, UK.12,14,16–18

49% of petients go untreated MR

Up to 49% of patients with symptomatic MR go untreated.14

Learn more about MR

Treatment options to address MR

For severe, symptomatic DMR, surgical mitral valve repair is the preferred choice for patients who are operable, not high risk and where the results are expected to be durable. Mitral valve repair is associated with better survival than mitral valve replacement.17 Effective treatment of FMR starts with guideline-directed medical therapy (GDMT).17 For patients with severe FMR who remain symptomatic despite GDMT, surgery is recommended. For symptomatic patients who are not eligible for surgery, transcatheter edge-to-edge repair (TEER) should be considered, if patients meet the criteria suggesting an increased chance of responding to this therapy.17

Severe DMR17

  • Surgical mitral valve repair or replacement
  • TEER

FMR17

  • GDMT as initial approach for all patients with FMR
  • For patients with chronic, severe FMR who remain symptomatic despite GDMT:
    • Surgical intervention
    • TEER
Learn more about current treatment options
The next chapter in MR treatment is here

What is transcatheter edge-to-edge (TEER)?

Mitral TEER, also referred to as transcatheter mitral valve repair, is a percutaneous catheter-based approach that aims to restore mitral valve leaflet coaptation, thus reducing MR.19

Learn more about TEER
Pascal Platform
Pascal Platform

Who should you refer to a Heart Team?

Refer patients with severe, symptomatic MR despite GDMT to a Heart Team17

Early recognition is key.20 Patients who progress to severe disease should be referred for evaluation to a Heart Team when intervention is considered.17 The European Society of Cardiology/European Association for Cardio-Thoracic Surgery (ESC/EACTS) guidelines specify that symptomatic patients with severe DMR who are inoperable or at high surgical risk may be considered for TEER by the Heart Team.17 Additionally, patients with severe FMR may be considered for TEER, particularly if they are symptomatic despite GDMT and have significant symptoms and are not eligible for surgery. Careful patient selection is crucial to ensure the best possible outcomes.17,20


2021 ESC Guidelines for the diagnosis and treatment of acute and chronic HF21

DM patients

The following patients may be considered for TEER:

  • Severe MR and HF symptoms
  • Surgery contraindicated or high risk
FMR patients

Class IIa

The following patients should be considered for TEER:

  • Symptomatic despite GDMT
  • Ineligible for surgery
  • Not needing coronary revascularisation
  • Fulfil criteria for achieving a reduction in HF hospitalisation

Class IIb

The following patients may be considered for TEER:

  • Symptomatic despite GDMT
  • Ineligible for surgery
  • Not needing coronary revascularisation
  • And who do not fulfil criteria for achieving a reduction in HF hospitalisation

2021 ESC/EACTS Guidelines for the management of valvular heart disease17

DM patients

Class IIb

The following patients may be considered for TEER:

  • Symptomatic, severe MR
  • High surgical risk or inoperable, judged by the Heart Team
  • Fulfil echocardiographic criteria
  • Procedure not considered futile
FMR patients

Class I

The following patients should be considered for TEER:

  • Severe MR
  • Symptomatic despite GDMT
  • Ineligible for surgery
  • Fulfil criteria suggesting an increased chance of responding to the treatment

Class IIb

The following patients may be considered for TEER:

  • Severe MR
  • Symptomatic despite GDMT
  • Ineligible for surgery
  • And who do not fulfil criteria suggesting an increased chance of responding to the treatment


Learn about patient eligibility
Discover more

Help your patients start a new chapter - today

Discover a wealth of resources designed to deepen your understanding of MR and its treatment. Stay informed with our upcoming symposium announcements, access insightful discussions through our on-demand webinars, and explore the extensive TEER body of evidence.

Ready to learn more?

Access our exclusive resources
Exclusive resources of MR
Exclusive resources of MR

References

  1. Makkar R. CLASP IID randomised trial and registry: Two-year outcomes of transcatheter edge-to-edge repair for degenerative mitral regurgitation. PCR London Valves; 24–26 November 2024, London, UK.
  2. Dziadzko V, Clavel MA, Dziadzko M, et al. Outcome and undertreatment of mitral regurgitation: A community cohort study. Lancet. 2018;391(10124):960–969. doi:10.1016/s0140-6736(18)30473-2.
  3. Enriquez-Sarano M, Benfari G, Essayagh B. Mitral regurgitation: Quantify, integrate, and interpret in context. JACC Case Rep.2022;4(19):1242–1246. doi:10.1016/j.jaccas.2022.08.032.
  4. Spargias K, Lim DS, Makkar R, et al. Three-year outcomes for transcatheter repair in patients with mitral regurgitation from the CLASP study. Catheter Cardiovasc Interv. 2023;102(1):145–154. doi:10.1002/ccd.30686.
  5. Medicare Coverage Database. Transcatheter mitral valve repair (TMVR). Accessed 10 April 2025, https://www.cms.gov/medicare-coverage-database/view/ncacal-tracking-sheet.aspx?NCAId=273#:~:text=This%20new%20technology%20involves%20clipping%20together%20a%20portion,and%20potentially%20halt%20the%20progression%20of%20heart%20failure
  6. Penn Medicine. Mitral valve regurgitation. Accessed 10 April 2025, https://www.pennmedicine.org/for-patients-and-visitors/patient-information/conditions-treated-a-to-z/mitral-valve%20regurgitation?gh_jid=5107829003&wtime={seek_to_second_number}
  7. Otto CM, Nishimura RA, Bonow RO, et al. 2020 ACC/AHA guideline for the management of patients with valvular heart disease: A report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2021;143(5):e72–e227. doi:10.1161/CIR.0000000000000923.
  8. Hamid UI, Aksoy R, Sardari Nia P. Mitral valve repair in papillary muscle rupture. Ann Cardiothorac Surg. 2022;11(3):281–289. doi:10.21037/acs-2021-ami-23.
  9. El Sabbagh A, Reddy YNV, Nishimura RA. Mitral valve regurgitation in the contemporary era: Insights into diagnosis, management, and future directions. JACC Cardiovasc Imaging. 2018;11(4):628–643. doi:10.1016/j.jcmg.2018.01.009.
  10. Douedi S, Douedi H. Mitral regurgitation. StatPearls. StatPearls Publishing; 2025.
  11. Adams DH, Rosenhek R, Falk V. Degenerative mitral valve regurgitation: Best practice revolution. Eur Heart J. 2010;31(16):1958–1966. doi:10.1093/eurheartj/ehq222.
  12. Pavon AG, Guglielmo M, Mennilli PM, et al. The role of cardiovascular magnetic resonance in patients with mitral regurgitation. J Cardiovasc Dev Dis. 2022;9(11):399. doi:10.3390/jcdd9110399.
  13. Vajapey R, Kwon D. Guide to functional mitral regurgitation: A contemporary review. Cardiovasc Diagn Ther. 2021;11(3):781–792. doi:10.21037/cdt-20-277.
  14. Mirabel M, Iung B, Baron G, et al. What are the characteristics of patients with severe, symptomatic, mitral regurgitation who are denied surgery? Eur Heart J. 2007;28(11):1358–1365. doi:10.1093/eurheartj/ehm001.
  15. Cardioguide. Mitral regurgitation. Accessed 15 April 2025, https://www.cardioguide.ca/mitral-regurgitation/
  16. Cecchetto A, Nistri S, Mele D. Primary mitral regurgitation: Answers to clinical cardiologists’ most common questions. Accessed 14 March 2025, https://www.escardio.org/Councils/Council-for-Cardiology-Practice-(CCP)/Cardiopractice/primary-mitral-regurgitation-answers-to-clinical-cardiologists-most-common-que.
  17. Vahanian A, Beyersdorf F, Praz F, et al. 2021 ESC/EACTS Guidelines for the management of valvular heart disease: Developed by the Task Force for the management of valvular heart disease of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2022;43(7):561–632. doi:10.1093/eurheartj/ehab395.
  18. Cahill TJ, Prothero A, Wilson J, et al. Community prevalence, mechanisms and outcome of mitral or tricuspid regurgitation. Heart. 2021;107(12):1003–1009. doi:10.1136/heartjnl-2020-318482.
  19. Blackman DJ, Schlosshan D, Dawkins S. Mitral valve TEER in the UK: What you need to know as TEER becomes routinely available in the NHS. Br J Cardiol. 2023;30(4):34. doi:10.5837/bjc.2023.034.
  20. NICE. Heart valve disease presenting in adults; Investigation and management. Accessed 10 April 2025, https://www.nice.org.uk/guidance/ng208/chapter/Recommendations.
  21. McDonagh TA, Metra M, Adamo M, et al. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: Developed by the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) With the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J. 2021;42(36):3599–3726. doi:10.1093/eurheartj/ehab368.
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