Percutaneous mitral valve leaflet repair has revolutionized the treatment of heart failure patients with secondary mitral regurgitation, as well as it offers a valuable alternative to surgery for high risk patients with degenerative disease. More than one device is now available for leaflet repair, broadening the indications and improving outcomes, as well as complicating the decision-making algorithms. In the last two years, several trials and registries have enriched the evidence around these procedures, although many questions remain open. Two major clinical trials have provided opposing evidence, confirming that this field of cardiovascular medicine remains controversial. Probably, the challenge remains with the human factor: achieving optimal outcomes remains a challenge, highly depending on patient selection, timing and procedural details. Operator dependent factors are emerging as a key element, not unexpectedly, to achieve procedural excellence. Besides large randomized controlled trials, there is a large amount of knowledge emerging from real world registries. The review focus on what we can learn from registries and single center experiences as a complement to the large randomized trials.
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