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MitraClip for Secondary MR — RACP Adult Medicine MCQ

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HardCardiologyMitraClip for Secondary MRRACP Adult Medicine

A 78-year-old woman with severe functional (secondary) MR and HFrEF (LVEF 28%) is on maximised HF therapy (ARNI, beta-blocker, MRA, SGLT2i). She has NYHA III symptoms with persistent severe MR on echo. She is not a surgical candidate (STS score 12%). What is the most appropriate intervention?

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Correct answer: D — MitraClip

Severe secondary (functional) MR in HFrEF despite optimal medical therapy, not a surgical candidate, is an indication for transcatheter edge-to-edge repair (MitraClip/TEER). The COAPT trial showed significant reduction in HF hospitalisations and mortality with MitraClip for secondary MR in HFrEF with disproportionately severe MR relative to LV size. Patient selection is critical (COAPT criteria, not MITRA-FR criteria).

Reference: CSANZ – 2024 – VHD; COAPT Trial; ESC 2021 VHD