October 30, 2024Circulation
Transcatheter Repair Versus Surgery for Atrial Versus Ventricular Functional Mitral Regurgitation: A Post Hoc Analysis of the MATTERHORN Trial
Felix RudolphMartin GeyerStephan BaldusValeria Maria De LucaTorsten DoenstRoman PfisterJan GummertMirjam KeßlerPeter BoekstegersEdith LubosJörg SchröderHölger ThieleMalte KelmJörg HausleiterIngo EitelUlrich Fischer‐RasokatAlexander BufeAlexander SchmeißerHüseyin İncePhilipp LurzRalph Stephan von BardelebenChristian HaglThilo NoackSebastian ReithHarald BeucherHermann ReichenspurnerWolfgang RottbauerP. Christian SchulzeWiebke MüllerJulia FrankClaudia MichalikMartin HellmichThorsten WahlersVolker RudolphChristos Iliadis
Key result
Transcatheter repair versus surgery for atrial versus ventricular FMR reports no results in MATTERHORN analysis.
Key Points
- To compare the clinical efficacy and safety of transcatheter mitral valve repair against surgical intervention in patients with atrial versus ventricular functional mitral regurgitation.
- Post hoc subgroup analysis of patients enrolled in the randomized MATTERHORN trial.
- Patients with functional mitral regurgitation were categorized into atrial versus ventricular etiologies and evaluated following transcatheter repair or surgical treatment.
- Comparative efficacy and safety profiles of transcatheter repair versus surgical intervention were characterized across atrial and ventricular functional mitral regurgitation subtypes.
- Treatment responses and clinical outcomes varied according to the underlying anatomical mechanism driving the mitral valve dysfunction.
PICO
P
Population
Atrial and Ventricular Functional Mitral Regurgitation
I
Intervention / Comparator
Transcatheter Repair vs Surgery
Key expert perspectives
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“We designed the MATTERHORN trial because treatment algorithms for patients with secondary mitral regurgitation are still not entirely evaluated. We know that secondary mitral regurgitation has a worse prognosis. However, we don't know whether surgery in surgical candidates or transcatheter therapy is superior.”
“TEER is commonly used to treat patients with secondary MR, but there has been no randomized trial comparing it with traditional surgery. In the MATTERHORN trial, we were able to show non-inferiority between the two techniques for improving MR—both methods worked well—with some safety benefits favoring TEER.”
“The MATTERHORN trial is the first randomized trial to demonstrate the non-inferiority of TEER and surgery in patients with secondary MR. These new data may become important to guide decision making as European guidelines currently recommend TEER may be considered in patients who are judged inoperable or at high surgical risk by the Heart Team.”
Implication
Hypothesis-generating for etiology-specific transcatheter versus surgical repair in functional MR; prospective trials required before clinical adoption.
Abstract
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Cite This Study
Rudolph et al. (2024) studied Atrial and Ventricular Functional Mitral Regurgitation. Transcatheter Repair vs. Surgery was evaluated. This post hoc analysis of the MATTERHORN trial evaluated transcatheter repair versus surgery for atrial versus ventricular functional mitral regurgitation, though no results were provided in the abstract.