This protocol targets patients with severe ventricular secondary mitral regurgitation (SMR) and impaired left ventricular ejection fraction (LVEF <50%), in the absence of concomitant coronary artery disease. The degree of systolic dysfunction is central to risk stratification and shapes the choice of intervention.
Management centres on a catheter-based valvular procedure for haemodynamically stable symptomatic patients meeting specific clinical and echocardiographic criteria. For those not suitable for that approach, a surgical pathway or, in the setting of advanced heart failure, more definitive mechanical or transplant strategies may be considered. The complete decision algorithm, patient selection criteria, and sequencing are available in the full protocol.
DOI: 10.1093/eurheartj/ehaf194
TEER is recommended to reduce HF hospitalizations and improve quality of life in haemodynamically stable, symptomatic patients with impaired LVEF (<50%) and persistent severe ventricular SMR, despite optimized GDMT and CRT (if indicated), fulfilling specific clinical and echocardiographic criteria.
MV surgery may be considered in symptomatic patients with severe ventricular SMR without advanced HF who are not suitable for TEER.
Heart transplantation or left ventricular assist device (LVAD) implantation should be considered in selected patients with severe ventricular SMR and advanced HF.
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