Takashi Matsumoto
Shonan Kamakura General Hospital, Japan Takashi Matsumoto, MD stressed the benefit of transcatheter edge-to-edge mitral valve repair (TEER) for severe secondary mitral regurgitation (MR), regardless of the acute or chronic disease.

The multicenter, randomized, controlled, parallel-group, open-label trial, COAPT (Transcatheter Mitral-Valve Repair in Patients with Heart Failure) trial demonstrated that transcatheter mitral valve repair resulted in lower rates of hospitalization for heart failure (HF) and all-cause mortality within 24 months of follow-up compared with medical therapy alone in patients with moderate to severe or severe secondary MR who remained symptomatic despite maximum guideline-directed medical therapy. Furthermore, this outcome benefit was also showed at 5 years of follow-up.

However, the Mitra FR trial, similar with the COAPT trial that confirmed the effect of TEER on MR, did not show a significant reduction in clinical events. There are several reasons for this: differences in the severity of MR and LV remodeling between the two trials, and guideline directed medical therapy was not optimized before procedure and the quality of procedure was not good in Mitra FR trial. Nonetheless, in the landmark analysis of the Mitra FR trial analyzing patients who survived for 1 year without hospitalization for HF, the primary end point was the cumulative number of HF hospitalization at 1 year, and although it was not statistically significant, a clear reduction in the incidence of HF hospitalizations was observed in the device group.

And COAPT post-approval study, a prospective, single-arm, observational study, enrolled 5,000 patients in United States, comparing COAPT like patients with Mitra like patients. In both groups, there was a similar and durable reduction of MR and a significant improvement in quality of life at 1year. He presented sub-analysis of EXPANDed Study presented at the New York Valve conference. It evaluated clinical events after MitraClip in moderate or severe MR. In both groups, there was a significant reduction in MR severity, LV reverse remodeling, symptom improvement and significant reduction in HF hospitalization.

He emphasized the importance of TEER by presenting a case summary showing how to treat MR in acute decompensated heart failure with acute MR. Although it is still difficult to establish the indication and timing of urgent TEER, he concluded that TEER is a very strong treatment option for this dynamic acute functional MR and can immediately reduce MR with a very high safety profile.

Live Case & Lecture 6: Mitral TEER

Friday, August 09, 2:00 PM ~ 3:40 PM
Main Arena, Vista Hall 1, B2

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