Percutaneous mitral valve leaflet repair has revolutionised the treatment of heart failure patients with secondary mitral regurgitation. It also 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 dependent on patient selection, timing and procedural details. Operator-dependent factors are emerging as a key element, not unexpectedly, to achieve procedural excellence. Besides large randomised controlled trials, a great deal of knowledge is emerging from real-world registries. This review focuses on what we can learn from registries and single-centre experiences as a complement to the large randomised trials.
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