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Percutaneous mitral valve leaflet repair for mitral regurgitation: NICE guidance
  1. H M Omar Farouque,
  2. David J Clark
  1. Department of Cardiology, Austin Health, Heidelberg, Australia
  1. Correspondence to Associate Professor Omar Farouque, Department of Cardiology, Austin Health, 145 Studley Road, Heidelberg VIC 3084, Australia; omar.farouque{at}

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Acquired valvular heart disease is an important global public health problem. Recent evidence confirms that this group of disorders is prevalent and increases with advancing age. In population-based studies of valvular heart disease, mitral regurgitation (MR) was found to be the most common valve lesion.1 The mitral valve is a complex structure consisting of anterior (aortic) and posterior (mural) leaflets, chordae tendinae, papillary muscles and the mitral annulus.2 Disease processes affecting any one of these components or distortion in the geometry of the mitral valve complex may result in MR. Common causes include myxomatous or degenerative valve disease, ischaemic heart disease, rheumatic heart disease or ‘functional’ MR due to mitral annular and left ventricular dilatation as seen in patients with dilated cardiomyopathy.

Patients with chronic severe MR typically remain asymptomatic for many years; however, when symptoms become manifest outcomes with medical treatment alone are poor.3 The standard of care has been either mitral valve replacement or, preferably, mitral valve repair, if the anatomical characteristics are suitable, with a low operative risk in contemporary practice.4 In recent years, there has been great enthusiasm in the interventional community for a less invasive, percutaneous catheter-based approach to dealing with certain forms of valve disease. The clinical impetus for the development of these techniques includes the potential for lowered morbidity, shorter hospital length of stay and recovery time and application to patients who might not otherwise be considered for a traditional surgical approach. Transcatheter treatments of calcific aortic valve stenosis are already being applied in many centres world wide, and now transcatheter treatments for MR are on our doorstep. In 2008, percutaneous mitral valve leaflet repair for severe MR with the MitraClip device (Evalve, Menlo Park, CA, USA) gained CE mark approval and already over 200 procedures have been performed …

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  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.