Percutaneous Repair or Surgery for Mitral Regurgitation

By Robert C. Gorman, Matthew J. Gillespie, J. Gorman. New England Journal of Medicine, 2011

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The Endovascular Valve Edge-to-Edge Repair Study (EVEREST II; ClinicalTrials.gov number, NCT00209274) is important, since the technology under study is an initial step toward extending percutaneous therapy for valvular heart disease to patients with mitral regurgitation. Of equal or greater importance, however, is that the study represents the first time a multi-institutional cohort of patients undergoing surgical mitral-valve repair has been followed prospectively with echocardiography for any length of time. The results in the surgery group of the trial are highly disappointing: within 1 year after surgery, 20% of the patients had grade 3+ or 4+ mitral regurgitation and 2% of the patients had such severe recurrent mitral regurgitation that repeat surgery was required. A surgically placed valve prosthesis that was associated with such poor early results would probably not receive regulatory approval. These sobering findings call into question the widespread enthusiasm for mitral repair that is now supported by current American College of Cardiology and American Heart Association guidelines. 1 The results of EVEREST II also set a low standard against which emerging percutaneous approaches for mitral regurgitation need be compared.

Subfields: Cardiology and Cardiovascular Medicine, Epidemiology, Surgery

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