Transcatheter edge-to-edge repair (TEER) was as effective as surgery for treating patients with secondary mitral regurgitations (MR), according to findings from the MATTERHORN trial presented at ESC Congress 2024 in London and simultaneously published in the New England Journal of Medicine. Researchers also noted that TEER had a better safety profile compared with surgical intervention.

Researchers recruited 210 high-risk surgical patients (mean age 75 years; 40% women) with secondary MR, left ventricular ejection fraction of ≥20%, and symptoms of heart failure despite optimal medical management from 16 centers in Germany. Participants were randomized to mitral TEER or surgery, with 72% of those in the surgical group undergoing mitral valve repair and 28% undergoing mitral valve replacement.

Results found no significant difference in the primary composite endpoint of death, hospitalization for heart failure, mitral reintervention, assist device implantation and stroke at one year (16.7% (TEER) vs. 22.5% (surgery), respectively), confirming noninferiority (p<0.01 for noninferiority). In addition, after one year, 73.2% of patients in the TEER group and 87.3% of patients in the surgical group had MR grade ≤1, highlighting the efficacy of both therapies, according to investigators.

In other findings, the primary composite safety endpoint occurred in significantly more patients in the surgical group (54.8%) compared with the TEER group (14.9%), due largely to more major bleeding (29% vs. 3%, respectively), all reinterventions (19% vs. 8%) and new onset atrial fibrillation (33% vs. 9%).

"The MATTERHORN trial is the first randomized trial to demonstrate the noninferiority of TEER and surgery in patients with secondary MR," said Stephan Baldus, MD, FACC, one of the study investigators. "These new data may become important to guide decision-making."