Dr. Asmar
Clinical question: Does transcatheter mitral valve repair of secondary mitral regurgitation improve hospitalization rates and mortality in patients with refractory symptoms despite maximal medical therapy?
Background: Patients with left ventricular cardiomyopathy and secondary mitral regurgitation have an increased risk of heart failure hospitalizations and reduced survival. Previously, the COAPT Trial showed safety and improved outcomes of transcatheter repair using MitraClip at two years. This study assessed outcomes after a five-year follow-up.
Study design: Open-label randomized-controlled trial
Setting: Multicenter study across 78 centers in the U.S. and Canada
Synopsis: 614 patients with ischemic or nonischemic cardiomyopathy and ejection fraction 20% to 50% with both moderate-to-severe or severe secondary mitral regurgitation by TTE and NYHA II or greater functional status were randomized to undergo guideline-directed medical therapy with or without transcatheter mitral valve repair. Those who underwent transcatheter repair were noted to have an average annual hospitalization rate of 33.1% compared to 57.2% in controls (HR, 0.53; 95% CI, 0.41-0.68). Similarly, five-year mortality in those who received the intervention was 57.3% compared to 67.1% in controls (HR, 0.72; 95% CI, 0.58-0.89).
Bottom line: Transcatheter secondary mitral regurgitation valve repair in symptomatic patients despite guideline-directed therapy decreases hospitalization rates and mortality on five-year follow-up.
Citation: Stone GW, Abraham WT, et al. Five-Year follow-up after transcatheter repair of secondary mitral regurgitation. N Engl J Med. 2023;388(22):2037-48.
Dr. El Asmar is a hospitalist at Johns Hopkins Hospital and an assistant professor of medicine at Johns Hopkins University School of Medicine in Baltimore.