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

Aug 31, 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:
08/31/2024
Date Published:
08/31/2024
Date Updated:
08/31/2024
Original Posted Date:
08/31/2024
References

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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