Approach to Mitral Regurgitation in Advanced Heart Failure.

Secondary mitral regurgitation (MR) is a common and prognostically important complication of heart failure that results from adverse ventricular remodeling rather than intrinsic valve pathology. While optimized heart failure medical therapy remains the foundation of treatment, selected patients with disproportionately severe MR may benefit from transcatheter edge-to-edge repair based on the COAPT trial results. Careful phenotyping to identify appropriate candidates-generally those with severe MR but less extreme ventricular dilatation-is essential, as intervention in patients with proportionate MR has not shown benefit.