41
Figure 10. Treatment Approach in Secondary Mitral Regurgitation
7.5. Valvular Heart Disease
COR LOE
Recommendations
1 B-R 1. In patients with HF, VHD should be managed in a
multidisciplinary manner in accordance with clinical practice
guidelines for VHD to prevent worsening of HF and adverse
clinical outcomes.
1 C-LD 2. In patients with chronic severe secondary MR and HFrEF,
optimization of GDMT is recommended before any
intervention for secondary MR related to LV dysfunction.
Severe stage D MR
(RVol ≥60 mL, RF ≥50%,
ERO ≥0.40 cm
2
)
GDMT supervised by
an HF specialist
(1)
Undergoing
CABG
Transcatheter edge-
to-edge MV repair
(2a)
MV
surgery*
(2a)
MV surgery
(2b)
MV surgery
(2b)
LVEF <50%
Severe
persistent
symptoms on
optimal GDMT
and AF Rx
Persistent
symptoms on
optimal GDMT
LVEF ≥50%
Severe
symptoms
NO
Mitral anatomy
favorable;
LVEF 20%–50%;
LVESD ≤70 mm;
PASP ≤70 mm Hg
