Cardiac resynchronization therapy (CRT) has been associated to left ventricle (LV) remodelling, reduction of functional mitral regurgitation (FMR) and clinical improvement in patients with heart failure and reduced ejection fraction (HFrEF). The prevalence of significant FMR in patients with LV dyssynchrony that are candidate to CRT is up to 40%. Current approach in patients with FMR undergoing CRT consists of re-evaluation of the amount of FMR following a waiting period of at least 3 months after the implant. In case of persistent significant FMR despite CRT and guideline directed medical therapy, trancatheter Mitral Valve repair (TMVR) is an important option to improve quality of life and prognosis. This stepwise approach does not take into account the probability of the individual response to CRT and the availability of TMVR solutions that are safe and effective in high risk patients. We reviewed the effects of CRT on FMR, the prognostic role of persistence of FMR after CRT treatment and the impact of treatment of FMR in patients CRT non responders. We aimed to point out the limits of current step-wised approach in light on more recent evidence regarding FMR treatment. A new, “tailored” approached is proposed.

心脏再同步治疗（CRT）已与左心室（LV）重塑，功能性二尖瓣反流（FMR）减少以及心力衰竭和射血分数降低（HFrEF）的患者的临床改善相关。可以作为CRT的左室不同步患者中显着的FMR患病率高达40％。在接受CRT的FMR患者中，当前的方法包括在植入后至少等待3个月后重新评估FMR的量。在尽管进行了CRT和指导性药物治疗的情况下，如果持续存在显着的FMR，经导管二尖瓣修复（TMVR）是改善生活质量和预后的重要选择。这种逐步的方法没有考虑对CRT个体反应的可能性以及在高风险患者中安全有效的TMVR解决方案的可用性。我们回顾了CRT对FMR的影响，CRT治疗后FMR持续存在的预后作用以及FMR治疗对CRT无反应者的影响。我们旨在根据有关FMR治疗的最新证据指出当前分步实施方法的局限性。提出了一种新的“量身定制”的方法。