Secondary Mitral Regurgitation: Updated Review with Focus on Percutaneous Interventional Management.

• To review contemporary approaches for the management of severe secondary mitral regurgitation with a focus on currently available and evidence-based percutaneous treatment options. • Emerging transcatheter mitral valve repair and replacement technologies may offer superior, complementary or synergistic treatment options in patients ineligible for transcatheter edge-to-edge repair, potentially revolutionizing the management of severe secondary mitral regurgitation. Secondary mitral regurgitation (SMR) is associated with increased mortality and heart failure hospitalizations. The management of heart failure patients with SMR is complex and requires a multidisciplinary Heart Team approach. Guideline-directed medical therapies remain fundamental, yet in a proportion of patients SMR persists. In the past decade, transcatheter edge-to-edge repair (TEER) has been shown to improve survival in patients with SMR who remain symptomatic despite medical therapy. Technical advancements across newer generations of devices, improved imaging, and greater operator expertise have collectively contributed to the increased safety and efficacy of this procedure over time. Various emerging transcatheter mitral valve repair and replacement devices are currently under investigation and may offer superior, complementary or synergistic treatment options in patients ineligible for TEER. This review provides a state-of-the-art overview regarding the diagnosis of SMR, and currently available transcatheter mitral valve interventions and describes a contemporary approach to the management of SMR. Visual take-home graphic: Step-by-step management pathway for patients with secondary mitral regurgitation. ACEI: angiotensin-converting enzyme inhibitor, AF: atrial fibrillation, ARB: angiotensin (II) receptor blocker, ARNI: angiotensin receptor-neprilysin inhibitor, CABG: coronary artery bypass grafting, CRT: cardiac resynchronization therapy, EROA: effective regurgitant orifice area, LVAD: left ventricle assist device, LVEF: left ventricle ejection fraction, MR: mitral regurgitation, MRA: mineralocorticoid receptor antagonists, MV: mitral valve, PCI: percutaneous coronary intervention, RF: regurgitant fraction, RV: right ventricle, R Vol: regurgitant volume, SGLT2: sodium-glucose cotransporter-2 inhibitors, TEE: trans-esophageal echocardiography, TEER: transcatheter edge-to-edge repair, TMVr: transcatheter mitral valve repair, TMVR: transcatheter mitral valve replacement, TTE: trans-thoracic echocardiography. [Display omitted] [ABSTRACT FROM AUTHOR]