Secondary Mitral Regurgitation — EECC MCQ

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HardValvular Heart DiseaseSecondary Mitral RegurgitationEECC

A 72-year-old man with severe secondary (ventricular) mitral regurgitation, ischaemic cardiomyopathy (LVEF 28%), and NYHA class III symptoms despite optimal GDMT is discussed at the Heart Team. His LVESD is 55 mm and EROA is 0.3 cm2. He is not a candidate for revascularisation. What is the recommended intervention?

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Correct answer: C — Transcatheter edge-to-edge repair (TEER) should be considered

This is severe symptomatic secondary (ventricular/functional) mitral regurgitation due to ischaemic LV systolic dysfunction, with persistent NYHA III symptoms despite optimal guideline-directed medical therapy. He is not undergoing or suitable for revascularisation, and the Heart Team has deemed surgical options inappropriate; in this setting UK guidance recommends considering transcatheter mitral edge-to-edge repair (TEER) if anatomically suitable. TEER is therefore the recommended intervention. TAVI is for aortic valve disease, not native mitral regurgitation. Isolated surgical annuloplasty or mitral valve replacement is not the preferred answer here because surgery for secondary MR is generally considered when another cardiac surgical indication exists or surgery is otherwise suitable. Continuing medical therapy alone is insufficient as the question states ongoing severe symptoms despite optimal therapy.

Reference: NICE guideline NG208, Heart valve disease presenting in adults: investigation and management (2021, current), recommendation 1.5.14: consider transcatheter mitral edge-to-edge repair for adults with heart failure and severe secondary mitral regurgitation if surgery is unsuitable and they remain symptomatic on medical management. https://www.nice.org.uk/guidance/ng208/chapter/recommendations