Transcatheter Versus Surgical Mitral Valve Repair in Patients With Heart Failure and Secondary Mitral Regurgitation - MATTERHORN
Contribution To Literature:
The MATTERHORN trial showed that M-TEER is noninferior to surgical mitral valve repair regarding clinical efficacy and has a better safety profile.
Description:
The goal of the trial was to evaluate mitral transcatheter edge-to-edge repair (M-TEER) compared with surgical mitral valve repair among patients with secondary mitral regurgitation (MR).
Study Design
- Randomized
- Parallel
Patients with secondary MR were randomized to M-TEER (n = 104) versus surgical mitral valve repair (n = 104).
- Total number of enrollees: 208
- Duration of follow-up: 1 year
- Mean patient age: 70.5 years
- Percentage female: 40%
- Percentage with diabetes: 26%
Inclusion criteria:
- Secondary severe MR
- Left ventricular ejection fraction (LVEF) of ≥20%
- Symptoms of heart failure (New York Heart Association [NYHA] class ≥2) despite optimal guideline-directed medical therapy
Exclusion criteria:
- Additional severe valvular disease
- Undergone coronary revascularization or cardiac resynchronization therapy within 1 month before enrollment
Other salient features/characteristics:
- Mean LVEF: 43%
- NYHA class III or IV: 86%
- Median EuroSCORE II score: 3%
Principal Findings:
The primary efficacy outcome, death, heart failure hospitalization, mitral reintervention, assist device implantation, or stroke, was 16.7% in the M-TEER group vs. 22.5% in the surgery group (p for noninferiority < 0.001).
The primary safety outcome, death, myocardial infarction, major bleeding, stroke or transient ischemic attack, rehospitalization, reintervention, nonelective cardiovascular surgery, renal failure, deep wound infection, mechanical ventilation >48 hours, gastrointestinal complication requiring surgery, new-onset atrial fibrillation, septicemia, or endocarditis, was 14.9% in the M-TEER group vs. 54.8% in the surgery group (p < 0.001).
Secondary endpoints:
- Recurrence of grade 3+ or 4+ MR at 1 year: 8.9% in the M-TEER group vs. 1.5% in the surgery group (p for noninferiority = 0.02)
- All-cause death: 8.1% in the M-TEER group vs. 11.2% in the surgery group
- Median change in Minnesota Living With Heart Failure Questionnaire score from baseline to 1 year: −10 points in the M-TEER group vs. −5 points in the surgery group
- Median in-hospital stay after intervention: 4 days in the M-TEER group vs. 12 days in the surgery group
Interpretation:
Among patients with symptomatic severe MR, M-TEER is effective. Compared with surgical mitral valve repair, M-TEER was noninferior with regard to clinical efficacy. M-TEER also was associated with a better safety profile compared with surgery. M-TEER is a safe and effective treatment for symptomatic severe MR.
References:
Baldus S, Doenst T, Pfister R, et al., for the MATTERHORN Investigators. Transcatheter Repair Versus Mitral-Valve Surgery for Secondary Mitral Regurgitation. N Engl J Med 2024;Aug 31:[Epub ahead of print].
Presented by Dr. Volker Rudolph at the European Society of Cardiology Congress, London, UK, August 31, 2024.
Clinical Topics: Heart Failure and Cardiomyopathies, Valvular Heart Disease, Acute Heart Failure, Mitral Regurgitation
Keywords: Heart Failure, Mitral Valve Insufficiency, ESC24, ESC Congress
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