Invitation to participate at the International Prospective Registry on the treatment of secondary mitral regurgitation (REFORM 2)

Dear friends and colleagues,

The treatment of secondary mitral regurgitation (MR) experienced major progress in the last decades and continues to change rapidly due to innovations in the surgical and catheter-based field. However, not every patient with a secondary MR res ponds positively to MV intervention and those who benefit remain to be better defined. On the other hand, there has been a conceptual change in the surgical MV repair with an increasing focus on LV geometry to actively counteract LV remodeling. Patients with secondary MR and severe leaflet tenting may benefit from simultaneous subannular repair that can be added to a standard MV annuloplasty. Single-center results on subannular procedures are very promising, however, multicenter prospective data to support their use are still lacking. Therefore, such techniques must be compared with other established treatment strategies in secondary MR in a real-world scenario, including catheter-based procedures (MitraClip, catheter-based annuloplasty), surgical and transcatheter MV replacement and guidelines-directed medical therapy.

We aim to establish a prospective international open design registry to create a platform evaluating different treatment strategies in secondary MR. Institutional heart-teams are strongly encouraged to include secondary MR patients on an "all-comer" basis, to elucidate a real-world scenario in the treatment of secondary MR. Echocardiographic and MRI imaging data are of crucial value and, therefore, represent an important part of the Registry.

All participating centers will be provided with educational opportunities to visit expert centers performing subannular repair and to improve their skills in subannular repair procedures (i.e., training fellowships). Furthermore, an on-site proctor ing might be requested, as for the first 2-4 subannular repair procedures.

We feel that a prospective open design international Registry is an important and timely initiative to elucidate the modern treatment strategies in secondary MR. On behalf of Heart Valve Society, we would like to warmly invite you to join us in this important multicenter project!

For more infor:mation please email:

Evaldas Girdauskas and Michele De Bonis