Transcatheter Versus Surgical Mitral Valve Repair in Patients With Heart Failure and Secondary Mitral Regurgitation - MATTERHORN

Nov 20, 2024
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Author/Summarized by Author:
Anthony A. Bavry, MD,MPH,FACC
Summary Reviewer:
Kim A. Eagle, MD, MACC
Trial Sponsor:
Abbott Vascular
Date Presented:
11/13/2024
Date Published:
10/30/2024
Date Updated:
11/20/2024
Original Posted Date:
08/31/2024
References

Contribution To Literature:

Highlighted text has been updated as of November 13, 2024.

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

Atrial vs. ventricular functional MR:

  • Atrial functional MR (n = 34) vs. ventricular functional MR (n = 174)
  • Primary safety endpoint at 30 days: 17.6% in the M-TEER group vs. 82.4% in the surgery group among those with atrial functional MR (p < 0.001) and 31.7% in the M-TEER group vs. 69.6% in the surgery group among those with ventricular functional MR (p = 0.002)
  • Primary efficacy endpoint at 1 year: 21.4% in the M-TEER group vs. 29.4% in the surgery group among those with atrial functional MR (p for noninferiority = 0.058) and 15.9% in the M-TEER group vs. 20.8% in the surgery group among those with ventricular functional MR (p for noninferiority < 0.001)

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. Results appeared to be similar for atrial vs. ventricular functional MR. M-TEER is a safe and effective treatment for symptomatic severe MR.

References:

Rudolph F, Geyer M, Baldus S, et al. Transcatheter Repair Versus Surgery for Atrial Versus Ventricular Functional Mitral Regurgitation – A Post-Hoc Analysis of the MATTERHORN Trial. Circulation 2024;Oct 30:[Epub ahead of print].

Presented by Dr. Stephan Baldus at the Transcatheter Cardiovascular Therapeutics meeting (TCT 2024), Washington, DC, October 30, 2024.

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;391:1787-98.

Editorial: Chikwe J, Kittleson MM. Transcatheter Repair or Surgery for Functional Mitral Regurgitation. N Engl J Med 2024;391:1850-1.

Presented by Dr. Volker Rudolph at the European Society of Cardiology Congress, London, UK, August 31, 2024.

Clinical Topics: Cardiac Surgery, Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Valvular Heart Disease, Cardiac Surgery and Heart Failure, Cardiac Surgery and VHD, Acute Heart Failure, Interventions and Structural Heart Disease, Mitral Regurgitation

Keywords: Heart Failure, Mitral Valve Insufficiency, ESC24, ESC Congress, TCT24, Transcatheter Aortic Valve Replacement


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