Key result
Transcatheter mitral valve repair with the MitraClip device significantly reduced heart failure hospitalizations within 24 months compared to medical therapy alone (35.8% vs 67.9% per patient year).
Why the study?
Secondary mitral regurgitation is common in patients with left heart dysfunction and associated with poor outcomes, prompting evaluation of which patients benefit from percutaneous repair following the COAPT trial.
Does percutaneous mitral valve repair using the MitraClip device reduce heart failure hospitalizations and mortality in patients with heart failure and severe secondary mitral regurgitation on maximally tolerated GDMT?
Does percutaneous mitral valve repair using the MitraClip device reduce heart failure hospitalizations and mortality in patients with heart failure and severe secondary mitral regurgitation on maximally tolerated GDMT?
Absolute Event Rate: 35.8% vs 67.9%
p-value: p=<0.001
Percutaneous mitral valve repair with MitraClip represents a paradigm shift, significantly improving outcomes in a carefully selected subset of heart failure patients with severe secondary mitral regurgitation who remain symptomatic despite maximally tolerated guideline-directed medical therapy.
Supports percutaneous repair for selected HF patients with secondary MR after GDMT; extends COAPT into guideline recommendations.
Secondary mitral regurgitation (MR) is common in patients with left heart dysfunction and it is associated with poor outcomes. Findings from the Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients with Functional Mitral Regurgitation (COAPT) trial, published in 2018, suggest that in a subset of people with heart failure with secondary MR that persists despite optimization of guideline-directed medical therapies, there is now a role for percutaneous mitral valve repair using the MitraClip device. Defining which patients are most likely to benefit from MitraClip, and when, requires both a multidisciplinary approach centered on heart failure, as well as a recognition of the need for further research in this area.
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Schlendorf et al. (2020) conducted a review in Heart failure with secondary mitral regurgitation (n=614). Transcatheter mitral valve repair (MitraClip) plus GDMT vs. GDMT alone was evaluated on Heart failure hospitalizations within 24 months (p=<0.001). Transcatheter mitral valve repair with the MitraClip device significantly reduced heart failure hospitalizations within 24 months compared to medical therapy alone (35.8% vs 67.9% per patient year).
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