Management Strategy for Intervention for Secondary Mitral Regurgitation

Management Strategy for Intervention for Secondary Mitral Regurgitation

Management Strategy for Intervention for Secondary Mitral Regurgitation Mitral Regurgitation Mitral Regurgitation

«Flowchart»

Secondary mitral regurgitation

Secondary mitral regurgitation

Secondary mitral regurgitation

Secondary mitral regurgitation

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<Go to node 3> Node 3

<Go to node 4>

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<Go to node 4> Node 4

<End Node 3>

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GDMT supervised by an
HF specialist (1)

GDMT supervised by an
HF specialist (1)

GDMT supervised by an
HF specialist (1)

Severe MR stage D
(RVol ≥ 60mL, RF ≥ 50%, ERO ≥0.40 cm²)

Severe MR stage D
(RVol ≥ 60mL, RF ≥ 50%, ERO ≥0.40 cm²)

Severe MR stage D
(RVol ≥ 60mL, RF ≥ 50%, ERO ≥0.40 cm²)

≥ ≥ ≥ ²

Severe persistent symptoms
on optimal GDMT and AF Rx

Severe persistent symptoms
on optimal GDMT and AF Rx

Severe persistent symptoms
on optimal GDMT and AF Rx

Persistent symptoms
on optimal GDMT

Persistent symptoms
on optimal GDMT

Persistent symptoms
on optimal GDMT

MV surgery^* (2a)

MV surgery^* (2a)

MV surgery^* (2a)

^*

MV surgery (2b)

MV surgery (2b)

MV surgery (2b)

Mitral anatomy favorable LVEF
20%-50% LVESD ≥ 70mm
PASP ≥ 70mm Hg

Mitral anatomy favorable LVEF
20%-50% LVESD ≥ 70mm
PASP ≥ 70mm Hg

Mitral anatomy favorable LVEF
20%-50% LVESD ≥ 70mm
PASP ≥ 70mm Hg

≥
≥

Severe symptoms

Severe symptoms

Severe symptoms

End

End

End

No

No

No

Transcatheter edge-to-edge
MV repair (2a)

Transcatheter edge-to-edge
MV repair (2a)

Transcatheter

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<Next Node>

<Next Node>

LVEF ≥ 50%

LVEF ≥ 50%

≥ LVEF ≥50% ≥

LVEF < 50%

LVEF < 50%

LVEF <50%

Undergoing CABG

Undergoing CABG

Undergoing CABG