IMR Press / RCM / Volume 23 / Issue 5 / DOI: 10.31083/j.rcm2305180
Open Access Review
Insight from International Guidelines: do We Have Satisfactory Recommendations for Secondary Mitral Regurgitation?
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1 Department of Cardiac Surgery, Centre Cardiologique du Nord, 93200 Saint-Denis, France
2 Department of Cardiothoracic Surgery, Golden Jubilee National Hospital, G81 4DY Glasgow, UK
3 Department of Cardiac Surgery, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris, 94000 Creteil, France
4 Department of Anesthesia, Centre Cardiologique du Nord, 93200 Saint-Denis, France
*Correspondence: (Francesco Nappi)
Academic Editors: Antonio Mangieri and Alan Maisel
Rev. Cardiovasc. Med. 2022, 23(5), 180;
Submitted: 14 December 2021 | Revised: 4 February 2022 | Accepted: 16 February 2022 | Published: 17 May 2022
(This article belongs to the Special Issue The treatment of mitral regurgitation in the 21st Century)
Copyright: © 2022 The Author(s). Published by IMR Press.
This is an open access article under the CC BY 4.0 license.

Both the European Society of Cardiology (ESC) and the American College of Cardiology (ACC/AHA) have recently released guidelines on the management of patients with secondary mitral regurgitation. This includes defining, classifying, and assessing the severity of secondary mitral regurgitation. These guidelines are also the first to incorporate the use of transcatheter edge-to-edge repair in decision-making based on recent studies. The review highlights the strengths and shortcomings of these studies and the applicability and generalisability of these results to assist in decision-making for the heart time. It also emphasises the importance of shared decision-making via the heart team. Echocardiography plays an important role in the assessment of these patients although these may be specifically for primary mitral insufficiency. The optimal guideline-directed medical therapy should be the first line of treatment followed by mechanical intervention. The choice of intervention is best directed by a specialist multidisciplinary team. Concomitant revascularization should be performed in a subgroup of patients with severe secondary mitral regurgitation given the role of adverse LV remodelling in propagation of the dynamic secondary MR. The guidelines need further confirmation from high-quality studies in the near future to decision-making towards either TEER, mitral valve replacement, or mitral valve repair with or without a subvalvular procedure.

secondary mitral regurgitation
international guidelines
mitral valve surgery
transcatheter edge to edge valve repair
Fig. 1.
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