MITRAL VALVE REGURGITATION:
A WIDESPREAD HEART DISEASE
Major Burden to Patients and Society
Mitral Valve Regurgitation (or MR) is one of the most prevalent heart diseases. MR is caused by structural damage of the mitral valve, the heart valve between the upper left and lower left heart chambers. In the US alone, more than 5 million people are affected, with 250,000 new diagnoses every year. While many patients live undiagnosed with mild symptoms, the disease has a tendency to progress over lifetime and can cause severe health problems all the way to cardiac arrhytmia and sudden cardiac death. In the US and Europe, approximately 100,000 patients annually undergo surgical or cardiological interventions to treat MR.
"Underdiagnosed and Undertreated"
The only option to treat the cause of MR is a structural intervention aiming to repair or replace the mitral valve. For decades, structural interventions have been conducted via open heart surgery under use of a heart lung machine. While generally safe and effective, open heart interventions are complex and resource-intensive and entail a high degree of trauma and consequential recovery burden for the patient. Since the 1990s, minimally invasive, endoscopic surgical interventions with a decreased degree of trauma have been adopted. Nonetheless, even endoscopic surgery inflicts material cardiac tissue damage on the patient. As a consequence, MR remains an undertreated disease, as many patients are not eligible to surgery as they are considered to be either in too early or too late stage to be operated. With the advent of transcatheter technology during the last decade, a new treatment paradigm is starting to address this problem, shifting the treatment from heart surgery to an interventional cardiology operation: Transcatheter Mitral Valve Repair (TMVr) or Replacement.
GROWING BURDEN OF DISEASE
Driven by Demography
MR is the second most frequent cardiac disease with a prevalence between 1% and 2% among the entire population. Both the incidence and the severity of MR increase with age, resulting in ascending prevalences along the age groups. MR is particularly frequent in the age group of 75 years and older, where it reaches a prevalence of more than 10%, making it one of the most frequent health problems among the elderly population. The burden of disease is expected to grow proportionally with the share of elderly among the population, particularly in industrial nations in North America, Europe and the AsiaPacific region. As an example, the US Census Bureau projects the share of the elder population to increase from 13% in 2010 to 30% by 2030. As the prevalence and absolute burden of MR is generally expected to increase steadily in the coming decades, new treatment paradigms will be adopted.