Ovidio A. García-Villarreal, Colegio Mexicano de Cirugía Cardiovascular y Torácica, Ciudad de México, México
The transcatheter edge-to-edge repair constitutes a paradigm-shifting therapeutic approach for patients with severe mitral regurgitation who are deemed high-risk candidates for conventional mitral valve surgery. Despite its growing popularity, the long-term consequences of pos-procedural elevated mitral valve gradient on mortality and morbidity rates remain a topic of intense debate. The reciprocal relationship between mitral valve area reduction and mitral valve gradient augmentation, resulting from the clipping of both mitral leaflets, may potentially undermine the efficacy and feasibility of this procedure. Notably, a growing body of evidence suggests that careful consideration is essential to weigh the benefits and risks of reducing residual mitral regurgitation to ≤ 1+ at the expense of an increase in mean mitral valve gradient > 5 mm Hg. The effect that an elevated post-procedure mitral valve gradient may have on the final outcome, such as all-cause death or heart failure hospitalization rates, is currently a contentious matter. In this review, we will analyze some of the most pivotal factors relevant to this issue in order to provide a more comprehensive insight into the intricacies involved.
Keywords: Mitral valve gradient. Mitral regurgitation. Degenerative mitral regurgitation. Functional mitral regurgitation. Transcatheter edge-to-edge repair.