A severe secondary mitral regurgitation (SMR) can be found in a significant portion of patients affected by advanced heart failure (AHF). Conventional therapies (optimal medical therapy, devices, surgery) present restricted clinical efficacy in this stage of the left ventricle disease which is burdened by high mortality and morbidity rates. Although the treatment of choice is represented by heart transplantation (HTx), there is an unmet need related to the limited supply of donor hearts (as opposed to the growing prevalence of AHF) and the low eligibility of highly symptomatic patients. In case of concomitant severe SMR, transcatheter mitral valve therapies (repair and replacement) may play a crucial role in this setting. While a direct prognostic improvement after correction of SMR has yet to be proved, AHF patients can benefit from the following: hemodynamic stabilization, symptomatic relief, normalization of pulmonary arterial pressures, and reduction in hospitalizations for acute heart failure. Obtaining these results may lead to the clinical consequences of reaching the HTx in good enough clinical status (bridge to heart transplantation), becoming eligible for the HTx (bridge to HTx candidacy), and being delisted for clinical improvement (bridge to recovery). Therefore, achieving traditional secondary endpoints in patients with AHF and SMR can translate into significant clinical implications.

很大一部分晚期心力衰竭 (AHF) 患者会出现严重的继发性二尖瓣反流 (SMR)。传统疗法（最佳药物疗法、设备、手术）在左心室疾病的这一阶段的临床疗效有限，且死亡率和发病率很高。尽管首选的治疗方法是心脏移植（HTx），但由于供体心脏供应有限（与 AHF 患病率不断增加）以及症状严重的患者资格较低有关，因此存在未得到满足的需求。如果伴有严重的 SMR，经导管二尖瓣治疗（修复和置换）可能在这种情况下发挥至关重要的作用。虽然 SMR 校正后的直接预后改善尚未得到证实，但 AHF 患者可以从以下方面受益：血流动力学稳定、症状缓解、肺动脉压正常化以及急性心力衰竭住院率减少。获得这些结果可能会导致以下临床后果：达到足够好的临床状态（通往心脏移植的桥梁）、获得 HTx 资格（通往 HTx 候选资格的桥梁）以及因临床改善而被除名（通往康复的桥梁）。因此，在 AHF 和 SMR 患者中实现传统的次要终点可以转化为重大的临床意义。