{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T13:13:33Z","timestamp":1788441213351,"version":"build-2803163510"},"reference-count":86,"publisher":"IMR Press","issue":"8","license":[{"start":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T00:00:00Z","timestamp":1785888000000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Rev. Cardiovasc. Med."],"abstract":"<jats:p>Mitral regurgitation (MR) is the most prevalent valvular heart disease in developed countries, affecting approximately 1 in 50 individuals in the general population and about 1 in 10 individuals older than 75 years. Despite its frequency, MR remains a complex clinical challenge due to its heterogeneous etiology, variable natural history, and evolving therapeutic landscape. The 2025 ESC\/EACTS guidelines have introduced a paradigm shift, transitioning from a purely morphological classification to a mechanism-based framework that distinguishes primary, ventricular secondary, and atrial secondary MR. This review provides a comprehensive overview of contemporary MR management. We discuss the updated classification system and the associated implications for risk stratification, emphasizing how the underlying mechanism of MR influences prognosis and guides treatment selection. The diagnostics section addresses multimodality imaging strategies, detailing the complementary roles of echocardiography, cardiac magnetic resonance (CMR), and cardiac computed tomography (CCT) in assessing severity, characterizing anatomy, and planning interventions. The management section addresses optimization of medical therapy, surgical techniques (repair versus replacement, including conventional and minimally invasive approaches), and transcatheter interventions, with particular focus on mitral transcatheter edge-to-edge repair (M-TEER) and emerging transcatheter mitral valve replacement technologies. We propose an integrated, stepwise management algorithm that incorporates early risk markers, including natriuretic peptides, to guide the timing of intervention before irreversible myocardial damage occurs. The critical role of multidisciplinary heart valve teams (HVTs) in individualizing treatment decisions is highlighted throughout. Early recognition of MR and timely intervention are paramount to prevent progression to irreversible left ventricular dysfunction and heart failure. The mechanism-based classification enables more precise patient phenotyping and treatment tailoring. Transcatheter therapies have expanded therapeutic options for high-risk surgical patients, although careful patient selection remains essential. Natriuretic peptides have emerged as valuable biomarkers for identifying candidates who may benefit from earlier intervention. Contemporary MR management requires the integration of advanced imaging, mechanism-based classification, and collaborative decision-making within HVTs. As therapeutic options continue to expand, optimal outcomes depend on matching the right intervention to the right patient at the right time.<\/jats:p>","DOI":"10.31083\/rcm49149","type":"journal-article","created":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T12:17:46Z","timestamp":1788437866000},"source":"Crossref","is-referenced-by-count":0,"title":["Mitral Regurgitation in Contemporary Practice: From Diagnosis to Management"],"prefix":"10.31083","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4117-7171","authenticated-orcid":true,"given":"Carlo","family":"Gaspardone","sequence":"first","affiliation":[{"name":"Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-9503-5787","authenticated-orcid":true,"given":"Paolo","family":"Costa","sequence":"additional","affiliation":[{"name":"Institute of Cardiology, ASST Spedali Civili, University of Brescia, 25123 Brescia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuseppe","family":"Barone","sequence":"additional","affiliation":[{"name":"Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7398-3859","authenticated-orcid":true,"given":"Rosaria","family":"Sofia","sequence":"additional","affiliation":[{"name":"Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Riccardo","family":"Mager","sequence":"additional","affiliation":[{"name":"Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesca","family":"Braccischi","sequence":"additional","affiliation":[{"name":"Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9174-1004","authenticated-orcid":true,"given":"Riccardo","family":"Mazza","sequence":"additional","affiliation":[{"name":"Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3855-1815","authenticated-orcid":true,"given":"Marianna","family":"Adamo","sequence":"additional","affiliation":[{"name":"Institute of Cardiology, ASST Spedali Civili, University of Brescia, 25123 Brescia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3691-1709","authenticated-orcid":true,"given":"Francesco","family":"Maisano","sequence":"additional","affiliation":[{"name":"Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy"},{"name":"Department of Cardiac Surgery, Heart Valve Center, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1319-0010","authenticated-orcid":true,"given":"Cosmo","family":"Godino","sequence":"additional","affiliation":[{"name":"Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6691-8568","authenticated-orcid":true,"given":"Marco","family":"Metra","sequence":"additional","affiliation":[{"name":"Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy"},{"name":"Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy"},{"name":"Clinical Cardiology Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2022-774X","authenticated-orcid":true,"given":"Gabriele","family":"Fragasso","sequence":"additional","affiliation":[{"name":"Clinical Cardiology Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"16242","published-online":{"date-parts":[[2026,8,5]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","unstructured":"Enriquez-Sarano M, Akins CW, Vahanian A. Mitral regurgitation. Lancet (London, England). 2009; 373: 1382\u20131394.","DOI":"10.1016\/S0140-6736(09)60692-9"},{"key":"ref2","doi-asserted-by":"publisher","unstructured":"Figlioli G, Sticchi A, Christodoulou MN, Hadjidemetriou A, Amorim Moreira Alves G, De Carlo M, et al. Global Prevalence of Mitral Regurgitation: A Systematic Review and Meta-Analysis of Population-Based Studies. Journal of Clinical Medicine. 2025; 14: 2749.","DOI":"10.3390\/jcm14082749"},{"key":"ref3","doi-asserted-by":"publisher","unstructured":"Kodali SK, Velagapudi P, Hahn RT, Abbott D, Leon MB. Valvular Heart Disease in Patients \u226580 Years of Age. Journal of the American College of Cardiology. 2018; 71: 2058\u20132072.","DOI":"10.1016\/j.jacc.2018.03.459"},{"key":"ref4","doi-asserted-by":"publisher","unstructured":"Yadgir S, Johnson CO, Aboyans V, Adebayo OM, Adedoyin RA, Afarideh M, et al. Global, Regional, and National Burden of Calcific Aortic Valve and Degenerative Mitral Valve Diseases, 1990-2017. Circulation. 2020; 141: 1670\u20131680.","DOI":"10.1161\/CIRCULATIONAHA.119.043391"},{"key":"ref5","doi-asserted-by":"publisher","unstructured":"Agricola E, Ielasi A, Oppizzi M, Faggiano P, Ferri L, Calabrese A, et al. Long-term prognosis of medically treated patients with functional mitral regurgitation and left ventricular dysfunction. European Journal of Heart Failure. 2009; 11: 581\u2013587.","DOI":"10.1093\/eurjhf\/hfp051"},{"key":"ref6","doi-asserted-by":"publisher","unstructured":"Riccardi M, Pagnesi M, Lombardi CM, Anker SD, Maisano F, Butler J, et al. Moderate Secondary Mitral Regurgitation: Evolving Evidence and Management Strategies. Journal of the American College of Cardiology. 2025; 86: 813\u2013828.","DOI":"10.1016\/j.jacc.2025.07.019"},{"key":"ref7","doi-asserted-by":"publisher","unstructured":"Gaasch WH, Meyer TE. Left ventricular response to mitral regurgitation: implications for management. Circulation. 2008; 118: 2298\u20132303.","DOI":"10.1161\/CIRCULATIONAHA.107.755942"},{"key":"ref8","doi-asserted-by":"publisher","unstructured":"Praz F, Borger MA, Lanz J, Marin-Cuartas M, Abreu A, Adamo M, et al. 2025 ESC\/EACTS Guidelines for the management of valvular heart disease. European Heart Journal. 2025; 46: 4635\u20134736.","DOI":"10.1093\/eurheartj\/ehaf194"},{"key":"ref9","doi-asserted-by":"publisher","unstructured":"Writing Committee Members, Otto CM, Nishimura RA, Bonow RO, Carabello BA, Erwin JP 3rd, et al. 2020 ACC\/AHA Guideline for the Management of Patients With Valvular Heart Disease: Executive Summary: A Report of the American College of Cardiology\/American Heart Association Joint Committee on Clinical Practice Guidelines. Journal of the American College of Cardiology. 2021; 77: 450\u2013500.","DOI":"10.1016\/j.jacc.2020.11.035"},{"key":"ref10","doi-asserted-by":"publisher","unstructured":"Delling FN, Vasan RS. Epidemiology and pathophysiology of mitral valve prolapse: new insights into disease progression, genetics, and molecular basis. Circulation. 2014; 129: 2158\u20132170.","DOI":"10.1161\/CIRCULATIONAHA.113.006702"},{"key":"ref11","doi-asserted-by":"publisher","unstructured":"Stolz L, Doldi PM, Sannino A, Hausleiter J, Grayburn PA. The Evolving Concept of Secondary Mitral Regurgitation Phenotypes: Lessons From the M-TEER Trials. JACC. Cardiovascular Imaging. 2024; 17: 659\u2013668.","DOI":"10.1016\/j.jcmg.2024.01.012"},{"key":"ref12","doi-asserted-by":"publisher","unstructured":"Samad Z, Shaw LK, Phelan M, Glower DD, Ersboll M, Toptine JH, et al. Long-term outcomes of mitral regurgitation by type and severity. American Heart Journal. 2018; 203: 39\u201348.","DOI":"10.1016\/j.ahj.2018.05.001"},{"key":"ref13","doi-asserted-by":"publisher","unstructured":"Zoghbi WA, Levine RA, Flachskampf F, Grayburn P, Gillam L, Leipsic J, et al. Atrial Functional Mitral Regurgitation: A JACC: Cardiovascular Imaging Expert Panel Viewpoint. JACC. Cardiovascular Imaging. 2022; 15: 1870\u20131882.","DOI":"10.1016\/j.jcmg.2022.08.016"},{"key":"ref14","doi-asserted-by":"publisher","unstructured":"Pagnesi M, Riccardi M, Maisano F, Grapsa J, Barberis V, Abdelhamid M, et al. Epidemiology, pathophysiology, diagnosis and management of atrial functional mitral regurgitation: An expert opinion paper. ESC Heart Failure. 2025; 12: 3788\u20133805.","DOI":"10.1002\/ehf2.15405"},{"key":"ref15","doi-asserted-by":"publisher","unstructured":"Farhan S, Silbiger JJ, Halperin JL, Zhang L, Dukkipati SR, Vogel B, et al. Pathophysiology, Echocardiographic Diagnosis, and Treatment of Atrial Functional Mitral Regurgitation: JACC State-of-the-Art Review. Journal of the American College of Cardiology. 2022; 80: 2314\u20132330.","DOI":"10.1016\/j.jacc.2022.09.046"},{"key":"ref16","unstructured":"Zamorano JL, Manuel Monteagudo J, Mesa D, Gonzalez-Alujas T, Sitges M, Carrasco-Chinchilla F, et al. Frequency, Mechanism and Severity of Mitral Regurgitation: Are There any Differences Between Primary and Secondary Mitral Regurgitation? The Journal of Heart Valve Disease. 2016; 25: 724\u2013729."},{"key":"ref17","doi-asserted-by":"publisher","unstructured":"Zoghbi WA, Adams D, Bonow RO, Enriquez-Sarano M, Foster E, Grayburn PA, et al. Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation: A Report from the American Society of Echocardiography Developed in Collaboration with the Society for Cardiovascular Magnetic Resonance. Journal of the American Society of Echocardiography: Official Publication of the American Society of Echocardiography. 2017; 30: 303\u2013371.","DOI":"10.1016\/j.echo.2017.01.007"},{"key":"ref18","doi-asserted-by":"publisher","unstructured":"Lancellotti P, Pibarot P, Chambers J, La Canna G, Pepi M, Dulgheru R, et al. Multi-modality imaging assessment of native valvular regurgitation: an EACVI and ESC council of valvular heart disease position paper. European Heart Journal. Cardiovascular Imaging. 2022; 23: e171\u2013e232.","DOI":"10.1093\/ehjci\/jeab253"},{"key":"ref19","doi-asserted-by":"publisher","unstructured":"Reid A, Blanke P, Bax JJ, Leipsic J. Multimodality imaging in valvular heart disease: how to use state-of-the-art technology in daily practice. European Heart Journal. 2021; 42: 1912\u20131925.","DOI":"10.1093\/eurheartj\/ehaa768"},{"key":"ref20","doi-asserted-by":"publisher","unstructured":"Uretsky S, Morales DCV, Aldaia L, Mediratta A, Koulogiannis K, Marcoff L, et al. Characterization of Primary Mitral Regurgitation With Flail Leaflet and\/or Wall-Impinging Flow. Journal of the American College of Cardiology. 2021; 78: 2537\u20132546.","DOI":"10.1016\/j.jacc.2021.09.1382"},{"key":"ref21","doi-asserted-by":"publisher","unstructured":"Iwakura K, Ito H, Kawano S, Okamura A, Kurotobi T, Date M, et al. Comparison of orifice area by transthoracic three-dimensional Doppler echocardiography versus proximal isovelocity surface area (PISA) method for assessment of mitral regurgitation. The American Journal of Cardiology. 2006; 97: 1630\u20131637.","DOI":"10.1016\/j.amjcard.2005.12.065"},{"key":"ref22","doi-asserted-by":"publisher","unstructured":"Topilsky Y, Grigioni F, Enriquez-Sarano M. Quantitation of mitral regurgitation. Seminars in Thoracic and Cardiovascular Surgery. 2011; 23: 106\u2013114.","DOI":"10.1053\/j.semtcvs.2011.07.004"},{"key":"ref23","doi-asserted-by":"publisher","unstructured":"Garg P, Swift AJ, Zhong L, Carlh\u00e4ll CJ, Ebbers T, Westenberg J, et al. Assessment of mitral valve regurgitation by cardiovascular magnetic resonance imaging. Nature Reviews. Cardiology. 2020; 17: 298\u2013312.","DOI":"10.1038\/s41569-019-0305-z"},{"key":"ref24","doi-asserted-by":"publisher","unstructured":"Safarkhanlo Y, Berto MB, Spano G, Bernhard B, Sch\u00fctze J, Stark AW, et al. Reproducibility and reliability of flow quantification using CMR 2D-phase contrast and 4D-Flow in secondary mitral valve regurgitation. The International Journal of Cardiovascular Imaging. 2025; 41: 1341\u20131350.","DOI":"10.1007\/s10554-025-03421-x"},{"key":"ref25","doi-asserted-by":"publisher","unstructured":"Uretsky S, Argulian E, Narula J, Wolff SD. Use of Cardiac Magnetic Resonance Imaging in Assessing Mitral Regurgitation: Current Evidence. Journal of the American College of Cardiology. 2018; 71: 547\u2013563.","DOI":"10.1016\/j.jacc.2017.12.009"},{"key":"ref26","doi-asserted-by":"publisher","unstructured":"Liu B, Neil DAH, Premchand M, Bhabra M, Patel R, Barker T, et al. Myocardial fibrosis in asymptomatic and symptomatic chronic severe primary mitral regurgitation and relationship to tissue characterisation and left ventricular function on cardiovascular magnetic resonance. Journal of Cardiovascular Magnetic Resonance: Official Journal of the Society for Cardiovascular Magnetic Resonance. 2020; 22: 86.","DOI":"10.1186\/s12968-020-00674-4"},{"key":"ref27","doi-asserted-by":"publisher","unstructured":"Kitkungvan D, Yang EY, El Tallawi KC, Nagueh SF, Nabi F, Khan MA, et al. Prognostic Implications of Diffuse Interstitial Fibrosis in Asymptomatic Primary Mitral Regurgitation. Circulation. 2019; 140: 2122\u20132124.","DOI":"10.1161\/CIRCULATIONAHA.119.043250"},{"key":"ref28","doi-asserted-by":"publisher","unstructured":"Ge Y, Gupta S, Fentanes E, Aghayev A, Steigner M, Sobieszczyk P, et al. Role of Cardiac CT in Pre-Procedure Planning for Transcatheter Mitral Valve Replacement. JACC. Cardiovascular Imaging. 2021; 14: 1571\u20131580.","DOI":"10.1016\/j.jcmg.2020.12.018"},{"key":"ref29","doi-asserted-by":"publisher","unstructured":"McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, B\u00f6hm M, et al. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. European Heart Journal. 2021; 42: 3599\u20133726.","DOI":"10.1093\/eurheartj\/ehab368"},{"key":"ref30","doi-asserted-by":"publisher","unstructured":"Milwidsky A, Mathai SV, Topilsky Y, Jorde UP. Medical Therapy for Functional Mitral Regurgitation. Circulation. Heart Failure. 2022; 15: e009689.","DOI":"10.1161\/CIRCHEARTFAILURE.122.009689"},{"key":"ref31","doi-asserted-by":"publisher","unstructured":"Michalski B, Stankovic I, Pagourelias E, Ciarka A, Aarones M, Winter S, et al. Relationship of Mechanical Dyssynchrony and LV Remodeling With Improvement of Mitral Regurgitation After CRT. JACC. Cardiovascular Imaging. 2022; 15: 212\u2013220.","DOI":"10.1016\/j.jcmg.2021.08.010"},{"key":"ref32","doi-asserted-by":"publisher","unstructured":"Soulat-Dufour L, Lang S, Addetia K, Ederhy S, Adavane-Scheuble S, Chauvet-Droit M, et al. Restoring Sinus Rhythm Reverses Cardiac Remodeling and Reduces Valvular Regurgitation in Patients With Atrial Fibrillation. Journal of the American College of Cardiology. 2022; 79: 951\u2013961.","DOI":"10.1016\/j.jacc.2021.12.029"},{"key":"ref33","doi-asserted-by":"publisher","unstructured":"Kang DH, Park SJ, Sun BJ, Cho EJ, Kim DH, Yun SC, et al. Early surgery versus conventional treatment for asymptomatic severe mitral regurgitation: a propensity analysis. Journal of the American College of Cardiology. 2014; 63: 2398\u20132407.","DOI":"10.1016\/j.jacc.2014.02.577"},{"key":"ref34","doi-asserted-by":"publisher","unstructured":"Lazam S, Vanoverschelde JL, Tribouilloy C, Grigioni F, Suri RM, Avierinos JF, et al. Twenty-Year Outcome After Mitral Repair Versus Replacement for Severe Degenerative Mitral Regurgitation: Analysis of a Large, Prospective, Multicenter, International Registry. Circulation. 2017; 135: 410\u2013422.","DOI":"10.1161\/CIRCULATIONAHA.116.023340"},{"key":"ref35","doi-asserted-by":"publisher","unstructured":"Coutinho GF, Antunes MJ. Mitral valve repair for degenerative mitral valve disease: surgical approach, patient selection and long-term outcomes. Heart (British Cardiac Society). 2017; 103: 1663\u20131669.","DOI":"10.1136\/heartjnl-2016-311031"},{"key":"ref36","doi-asserted-by":"publisher","unstructured":"Badhwar V, Chikwe J, Gillinov AM, Vemulapalli S, O'Gara PT, Mehaffey JH, et al. Risk of Surgical Mitral Valve Repair for Primary Mitral Regurgitation. Journal of the American College of Cardiology. 2023; 81: 636\u2013648.","DOI":"10.1016\/j.jacc.2022.11.017"},{"key":"ref37","doi-asserted-by":"publisher","unstructured":"De Bonis M, Alfieri O, Dalrymple-Hay M, Del Forno B, Dulguerov F, Dreyfus G. Mitral Valve Repair in Degenerative Mitral Regurgitation: State of the Art. Progress in Cardiovascular Diseases. 2017; 60: 386\u2013393.","DOI":"10.1016\/j.pcad.2017.10.006"},{"key":"ref38","doi-asserted-by":"publisher","unstructured":"De Bonis M, Lapenna E, Lorusso R, Buzzatti N, Gelsomino S, Taramasso M, et al. Very long-term results (up to 17 years) with the double-orifice mitral valve repair combined with ring annuloplasty for degenerative mitral regurgitation. The Journal of Thoracic and Cardiovascular Surgery. 2012; 144: 1019\u20131024.","DOI":"10.1016\/j.jtcvs.2012.07.034"},{"key":"ref39","doi-asserted-by":"publisher","unstructured":"Chemtob RA, Wierup P, Mick S, Gillinov M. Choosing the \"Best\" surgical techniques for mitral valve repair: Lessons from the literature. Journal of Cardiac Surgery. 2019; 34: 717\u2013727.","DOI":"10.1111\/jocs.14089"},{"key":"ref40","doi-asserted-by":"publisher","unstructured":"Bortolotti U, Milano AD, Frater RWM. Mitral valve repair with artificial chordae: a review of its history, technical details, long-term results, and pathology. The Annals of Thoracic Surgery. 2012; 93: 684\u2013691.","DOI":"10.1016\/j.athoracsur.2011.09.015"},{"key":"ref41","doi-asserted-by":"publisher","unstructured":"Goldstone AB, Chiu P, Baiocchi M, Lingala B, Patrick WL, Fischbein MP, et al. Mechanical or Biologic Prostheses for Aortic-Valve and Mitral-Valve Replacement. The New England Journal of Medicine. 2017; 377: 1847\u20131857.","DOI":"10.1056\/NEJMoa1613792"},{"key":"ref42","doi-asserted-by":"publisher","unstructured":"Chikwe J, Chiang YP, Egorova NN, Itagaki S, Adams DH. Survival and outcomes following bioprosthetic vs mechanical mitral valve replacement in patients aged 50 to 69 years. JAMA. 2015; 313: 1435\u20131442.","DOI":"10.1001\/jama.2015.3164"},{"key":"ref43","doi-asserted-by":"publisher","unstructured":"Wu AH, Aaronson KD, Bolling SF, Pagani FD, Welch K, Koelling TM. Impact of mitral valve annuloplasty on mortality risk in patients with mitral regurgitation and left ventricular systolic dysfunction. Journal of the American College of Cardiology. 2005; 45: 381\u2013387.","DOI":"10.1016\/j.jacc.2004.09.073"},{"key":"ref44","doi-asserted-by":"publisher","unstructured":"Baldus S, Doenst T, Pfister R, Gummert J, Kessler M, Boekstegers P, et al. Transcatheter Repair versus Mitral-Valve Surgery for Secondary Mitral Regurgitation. The New England Journal of Medicine. 2024; 391: 1787\u20131798.","DOI":"10.1056\/NEJMoa2408739"},{"key":"ref45","doi-asserted-by":"publisher","unstructured":"Wagner CM, Brescia AA, Watt TMF, Bergquist C, Rosenbloom LM, Ceniza NN, et al. Surgical strategy and outcomes for atrial functional mitral regurgitation: All functional mitral regurgitation is not the same! The Journal of Thoracic and Cardiovascular Surgery. 2024; 167: 647\u2013655.","DOI":"10.1016\/j.jtcvs.2022.02.056"},{"key":"ref46","doi-asserted-by":"publisher","unstructured":"Balogh Z, Mizukami T, Bartunek J, Collet C, Beles M, Albano M, et al. Mitral Valve Repair of Atrial Functional Mitral Regurgitation in Heart Failure with Preserved Ejection Fraction. Journal of Clinical Medicine. 2020; 9: 3432.","DOI":"10.3390\/jcm9113432"},{"key":"ref47","doi-asserted-by":"publisher","unstructured":"El-Andari R, Watkins AR, Fialka NM, Kang JJH, Bozso SJ, Fatehi Hassanabad A, et al. Minimally Invasive Approaches to Mitral Valve Surgery: Where Are We Now? A Narrative Review. The Canadian Journal of Cardiology. 2024; 40: 1679\u20131689.","DOI":"10.1016\/j.cjca.2024.03.017"},{"key":"ref48","doi-asserted-by":"publisher","unstructured":"Akowuah EF, Maier RH, Hancock HC, Kharatikoopaei E, Vale L, Fernandez-Garcia C, et al. Minithoracotomy vs Conventional Sternotomy for Mitral Valve Repair: A Randomized Clinical Trial. JAMA. 2023; 329: 1957\u20131966.","DOI":"10.1001\/jama.2023.7800"},{"key":"ref49","doi-asserted-by":"publisher","unstructured":"Kainuma S, Kawamoto N, Kakuta T, Suzuki K, Yamashita K, Ikuta A, et al. Mitral valve repair by right minithoracotomy compared with sternotomy: 21-year single-center experience. The Journal of Thoracic and Cardiovascular Surgery. 2026; 171: 1059\u20131069.e3.","DOI":"10.1016\/j.jtcvs.2026.01.010"},{"key":"ref50","doi-asserted-by":"publisher","unstructured":"Bonatti J, Kiaii B, Alhan C, Cerny S, Torregrossa G, Bisleri G, et al. The role of robotic technology in minimally invasive surgery for mitral valve disease. Expert Review of Medical Devices. 2021; 18: 955\u2013970.","DOI":"10.1080\/17434440.2021.1960506"},{"key":"ref51","doi-asserted-by":"publisher","unstructured":"Arghami A, Jahanian S, Daly RC, Hemmati P, Lahr BD, Rowse PG, et al. Robotic Mitral Valve Repair: A Decade of Experience With Echocardiographic Follow-up. The Annals of Thoracic Surgery. 2022; 114: 1587\u20131595.","DOI":"10.1016\/j.athoracsur.2021.08.083"},{"key":"ref52","doi-asserted-by":"publisher","unstructured":"Fucci C, Sandrelli L, Pardini A, Torracca L, Ferrari M, Alfieri O. Improved results with mitral valve repair using new surgical techniques. European Journal of Cardio-thoracic Surgery: Official Journal of the European Association for Cardio-thoracic Surgery. 1995; 9: 621\u2013627.","DOI":"10.1016\/s1010-7940(05)80107-1"},{"key":"ref53","doi-asserted-by":"publisher","unstructured":"Hausleiter J, Stocker TJ, Adamo M, Karam N, Swaans MJ, Praz F. Mitral valve transcatheter edge-to-edge repair. EuroIntervention: Journal of EuroPCR in Collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology. 2023; 18: 957\u2013976.","DOI":"10.4244\/EIJ-D-22-00725"},{"key":"ref54","doi-asserted-by":"publisher","unstructured":"Feldman T, Foster E, Glower DD, Kar S, Rinaldi MJ, Fail PS, et al. Percutaneous repair or surgery for mitral regurgitation. New England Journal of Medicine. 2011; 364: 1395\u20131406.","DOI":"10.1056\/NEJMoa1009355"},{"key":"ref55","doi-asserted-by":"publisher","unstructured":"Lim DS, Smith RL, Gillam LD, Zahr F, Chadderdon S, Makkar R, et al. Randomized Comparison of Transcatheter Edge-to-Edge Repair for Degenerative Mitral Regurgitation in Prohibitive Surgical Risk Patients. JACC. Cardiovascular Interventions. 2022; 15: 2523\u20132536.","DOI":"10.1016\/j.jcin.2022.09.005"},{"key":"ref56","doi-asserted-by":"publisher","unstructured":"Stone GW, Lindenfeld J, Abraham WT, Kar S, Lim DS, Mishell JM, et al. Transcatheter Mitral-Valve Repair in Patients with Heart Failure. The New England Journal of Medicine. 2018; 379: 2307\u20132318.","DOI":"10.1056\/NEJMoa1806640"},{"key":"ref57","doi-asserted-by":"publisher","unstructured":"Stone GW, Abraham WT, Lindenfeld J, Kar S, Grayburn PA, Lim DS, et al. Five-Year Follow-up after Transcatheter Repair of Secondary Mitral Regurgitation. The New England Journal of Medicine. 2023; 388: 2037\u20132048.","DOI":"10.1056\/NEJMoa2300213"},{"key":"ref58","doi-asserted-by":"publisher","unstructured":"Obadia JF, Messika-Zeitoun D, Leurent G, Iung B, Bonnet G, Piriou N, et al. Percutaneous repair or medical treatment for secondary mitral regurgitation. New England Journal of Medicine. 2018; 379: 2297\u20132306.","DOI":"10.1056\/NEJMoa1805374"},{"key":"ref59","doi-asserted-by":"publisher","unstructured":"Anker SD, Friede T, von Bardeleben RS, Butler J, Khan MS, Diek M, et al. Transcatheter Valve Repair in Heart Failure with Moderate to Severe Mitral Regurgitation. The New England Journal of Medicine. 2024; 391: 1799\u20131809.","DOI":"10.1056\/NEJMoa2314328"},{"key":"ref60","doi-asserted-by":"publisher","unstructured":"Anker MS, Porthun J, Bonnet G, Schulze PC, Rassaf T, Landmesser U. Percutaneous Transcatheter Edge-to-Edge Repair for Functional Mitral Regurgitation in Heart Failure: A Meta-Analysis of 3 Randomized Controlled Trials. Journal of the American College of Cardiology. 2024; 84: 2364\u20132368.","DOI":"10.1016\/j.jacc.2024.08.026"},{"key":"ref61","doi-asserted-by":"publisher","unstructured":"Adamo M, Tomasoni D, Stolz L, Stocker TJ, Pancaldi E, Koell B, et al. Impact of Transcatheter Edge-to-Edge Mitral Valve Repair on Guideline-Directed Medical Therapy Uptitration. JACC. Cardiovascular Interventions. 2023; 16: 896\u2013905.","DOI":"10.1016\/j.jcin.2023.01.362"},{"key":"ref62","doi-asserted-by":"publisher","unstructured":"Ludwig S, Perrin N, Coisne A, Ben Ali W, Weimann J, Duncan A, et al. Clinical outcomes of transcatheter mitral valve replacement: two-year results of the CHOICE-MI Registry. EuroIntervention: Journal of EuroPCR in Collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology. 2023; 19: 512\u2013525.","DOI":"10.4244\/EIJ-D-22-01037"},{"key":"ref63","doi-asserted-by":"publisher","unstructured":"Coisne A, Ludwig S, Scotti A, Ben Ali W, Weimann J, Duncan A, et al. Outcomes Following Transcatheter Mitral Valve Replacement Using Dedicated Devices in Patients With Mitral Annular Calcification. JACC. Cardiovascular Interventions. 2024; 17: 2141\u20132153.","DOI":"10.1016\/j.jcin.2024.07.038"},{"key":"ref64","doi-asserted-by":"publisher","unstructured":"Alperi A, Granada JF, Bernier M, Dagenais F, Rod\u00e9s-Cabau J. Current Status and Future Prospects of Transcatheter Mitral Valve Replacement: JACC State-of-the-Art Review. Journal of the American College of Cardiology. 2021; 77: 3058\u20133078.","DOI":"10.1016\/j.jacc.2021.04.051"},{"key":"ref65","doi-asserted-by":"publisher","unstructured":"Ricciardi MJ, Singh G, Rogers JH, Ruf T, Rottbauer W, Horn P, et al. Atrial Secondary Mitral Regurgitation Outcomes Following Mitral Transcatheter Edge-to-Edge Repair: Results From the EXPANDed Studies. Circulation. Cardiovascular Interventions. 2026; 19: e015883.","DOI":"10.1161\/CIRCINTERVENTIONS.125.015883"},{"key":"ref66","doi-asserted-by":"publisher","unstructured":"Riebel CIB, Ilie Orzan R, Negru A, Agoston-Coldea L. The Role of Global Longitudinal Strain in the Follow-Up of Asymptomatic Patients with Chronic Primary Mitral Regurgitation. Journal of Clinical Medicine. 2024; 13: 5304.","DOI":"10.3390\/jcm13175304"},{"key":"ref67","doi-asserted-by":"publisher","unstructured":"Ueyama H, Kuno T, Takagi H, Krishnamoorthy P, Prandi FR, Palazzuoli A, et al. Prognostic value of left ventricular global longitudinal strain in mitral regurgitation: a systematic review. Heart Failure Reviews. 2023; 28: 465\u2013483.","DOI":"10.1007\/s10741-022-10265-3"},{"key":"ref68","doi-asserted-by":"publisher","unstructured":"Ratwatte S, Strange G, Playford D, Stewart S, Celermajer DS. Prevalence of pulmonary hypertension in mitral regurgitation and its influence on outcomes. Open Heart. 2023; 10: e002268.","DOI":"10.1136\/openhrt-2023-002268"},{"key":"ref69","doi-asserted-by":"publisher","unstructured":"Acar L, Behrendt CA, Baldus S, Falk V, Smetak N, Nzomo MM, et al. Prognostic impact of disease-related complications in asymptomatic mitral regurgitation: a health insurance claims analysis. Clinical Research in Cardiology: Official Journal of the German Cardiac Society. 2025; 114: 856\u2013866.","DOI":"10.1007\/s00392-024-02532-0"},{"key":"ref70","doi-asserted-by":"publisher","unstructured":"Mannina C, Sharma A, Prakash Y, Carbone A, Bossone E, Tuttolomondo A, et al. Impact of Atrial Fibrillation in Patients With Severe Mitral Regurgitation Undergoing Transcatheter Edge-to-Edge Repair. Journal of the American Heart Association. 2025; 14: e042016.","DOI":"10.1161\/JAHA.125.042016"},{"key":"ref71","doi-asserted-by":"publisher","unstructured":"Kim HJ, Kim YJ, Kim M, Yoo JS, Kim DH, Park DW, et al. Surgical ablation for atrial fibrillation during aortic and mitral valve surgery: A nationwide population-based cohort study. The Journal of Thoracic and Cardiovascular Surgery. 2024; 167: 981\u2013993.","DOI":"10.1016\/j.jtcvs.2022.08.038"},{"key":"ref72","doi-asserted-by":"publisher","unstructured":"Gallo G, Forte M, Stanzione R, Cotugno M, Bianchi F, Marchitti S, et al. Functional Role of Natriuretic Peptides in Risk Assessment and Prognosis of Patients with Mitral Regurgitation. Journal of Clinical Medicine. 2020; 9: 1348.","DOI":"10.3390\/jcm9051348"},{"key":"ref73","doi-asserted-by":"publisher","unstructured":"Adamo M, Pagnesi M, Di Pasquale M, Ravera A, Dickstein K, Ng LL, et al. Differential biomarker expression in heart failure patients with and without mitral regurgitation: Insights from BIOSTAT-CHF. International Journal of Cardiology. 2024; 399: 131664.","DOI":"10.1016\/j.ijcard.2023.131664"},{"key":"ref74","doi-asserted-by":"publisher","unstructured":"Uzel R, Rezar R, Bruno RR, Wernly S, Jung C, Delle Karth G, et al. Frailty as a predictor of mortality and readmission rate in secondary mitral regurgitation. Wiener Klinische Wochenschrift. 2023; 135: 696\u2013702.","DOI":"10.1007\/s00508-022-02138-4"},{"key":"ref75","doi-asserted-by":"publisher","unstructured":"Shamekhi J, Al-Kassou B, Weber M, Goody PR, Zimmer S, Germeroth J, et al. Mortality prediction of the frailty syndrome in patients with severe mitral regurgitation. Heart and Vessels. 2023; 38: 274\u2013283.","DOI":"10.1007\/s00380-022-02184-y"},{"key":"ref76","doi-asserted-by":"publisher","unstructured":"Deja MA, Grayburn PA, Sun B, Rao V, She L, Krejca M, et al. Influence of mitral regurgitation repair on survival in the surgical treatment for ischemic heart failure trial. Circulation. 2012; 125: 2639\u20132648.","DOI":"10.1161\/CIRCULATIONAHA.111.072256"},{"key":"ref77","doi-asserted-by":"publisher","unstructured":"Virk SA, Tian DH, Sriravindrarajah A, Dunn D, Wolfenden HD, Suri RM, et al. Mitral valve surgery and coronary artery bypass grafting for moderate-to-severe ischemic mitral regurgitation: Meta-analysis of clinical and echocardiographic outcomes. The Journal of Thoracic and Cardiovascular Surgery. 2017; 154: 127\u2013136.","DOI":"10.1016\/j.jtcvs.2017.03.039"},{"key":"ref78","doi-asserted-by":"publisher","unstructured":"Yousefzai R, Bajaj N, Krishnaswamy A, Goel SS, Agarwal S, Aksoy O, et al. Outcomes of patients with ischemic mitral regurgitation undergoing percutaneous coronary intervention. The American Journal of Cardiology. 2014; 114: 1011\u20131017.","DOI":"10.1016\/j.amjcard.2014.07.012"},{"key":"ref79","doi-asserted-by":"publisher","unstructured":"Est\u00e9vez-Loureiro R, Lorusso R, Taramasso M, Torregrossa G, Kini A, Moreno PR. Management of Severe Mitral Regurgitation in Patients With Acute Myocardial Infarction: JACC Focus Seminar 2\/5. Journal of the American College of Cardiology. 2024; 83: 1799\u20131817.","DOI":"10.1016\/j.jacc.2023.09.840"},{"key":"ref80","doi-asserted-by":"publisher","unstructured":"Massimi G, Matteucci M, Kowalewski M, Ronco D, Jiritano F, Beghi C, et al. Surgical treatment of post-infarction papillary muscle rupture: systematic review and meta-analysis. Annals of Cardiothoracic Surgery. 2022; 11: 252\u2013260.","DOI":"10.21037\/acs-2021-ami-15"},{"key":"ref81","doi-asserted-by":"publisher","unstructured":"Frazzetto M, Sanfilippo C, Briguglio F, Giacalone C, Contrafatto C, Munaf\u00f2 A, et al. Mitral Transcatheter Edge-to-Edge Repair in Acute Ischemic Mitral Regurgitation: Current Evidence and Future Perspectives. Reviews in Cardiovascular Medicine. 2025; 26: 33396.","DOI":"10.31083\/RCM33396"},{"key":"ref82","doi-asserted-by":"publisher","unstructured":"Nishimura RA, O'Gara PT, Bavaria JE, Brindis RG, Carroll JD, Kavinsky CJ, et al. 2019 AATS\/ACC\/ASE\/SCAI\/STS Expert Consensus Systems of Care Document: A Proposal to Optimize Care for Patients With Valvular Heart Disease: A Joint Report of the American Association for Thoracic Surgery, American College of Cardiology, American Society of Echocardiography, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. Journal of the American College of Cardiology. 2019; 73: 2609\u20132635.","DOI":"10.1016\/j.jacc.2018.10.007"},{"key":"ref83","doi-asserted-by":"publisher","unstructured":"Donal E, Unger P, Coisne A, Pibarot P, Magne J, Sitges M, et al. The role of multi-modality imaging in multiple valvular heart diseases: a clinical consensus statement of the European Association of Cardiovascular Imaging of the European Society of Cardiology. European Heart Journal. Cardiovascular Imaging. 2025; 26: 593\u2013608.","DOI":"10.1093\/ehjci\/jeaf026"},{"key":"ref84","doi-asserted-by":"publisher","unstructured":"Saeed S, Skaar E, Romarheim A, Chambers JB, Bleie \u00d8. Shared Decision-Making and Patient-Reported Outcome Measures in Valvular Heart Disease. Frontiers in Cardiovascular Medicine. 2022; 9: 863040.","DOI":"10.3389\/fcvm.2022.863040"},{"key":"ref85","doi-asserted-by":"publisher","unstructured":"Edpuganti S, Shamim A, Gangolli VH, Weerasekara RADKN, Yellamilli A. Artificial Intelligence in Cardiovascular Imaging: Current Landscape, Clinical Impact, and Future Directions. Discoveries (Craiova, Romania). 2025; 13: e211.","DOI":"10.15190\/d.2025.10"},{"key":"ref86","doi-asserted-by":"publisher","unstructured":"Vahanian A, Urena M, Ince H, Nickenig G. Mitral valve: repair\/clips\/cinching\/chordae. EuroIntervention: Journal of EuroPCR in Collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology. 2017; 13: AA22\u2013AA30.","DOI":"10.4244\/EIJ-D-17-00505"}],"container-title":["Reviews in Cardiovascular Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.imrpress.com\/journal\/RCM\/27\/8\/10.31083\/RCM49149","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T12:19:09Z","timestamp":1788437949000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.imrpress.com\/journal\/RCM\/27\/8\/10.31083\/RCM49149"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,5]]},"references-count":86,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2026]]}},"alternative-id":["S1530-6550(26)02427-0"],"URL":"https:\/\/doi.org\/10.31083\/rcm49149","relation":{},"ISSN":["1530-6550","2153-8174"],"issn-type":[{"value":"1530-6550","type":"print"},{"value":"2153-8174","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,5]]},"article-number":"49149"}}