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Transcatheter mitral-valve repair reduces hospitalization and mortality from heart failure

30 Jan 2019

Patients with heart failure who have mitral regurgitation due to left ventricular dysfunction show poor prognosis. As many patients remain symptomatic despite maximal doses of guideline-directed medical therapy, it was evaluated whether transcatheter mitral-valve repair would improve clinical outcomes.

614 patients were enrolled in the multicenter, randomized, controlled, parallel-group, open-label COAPT trial. 302 were assigned to the device group, receiving valve repair (Abbott’s MitraClip device) and guideline-directed medical therapy. 312 were appointed to the control group receiving medical therapy only.

In the group receiving transcatheter mitral-valve repair, the rate of all hospitalizations for heart failure (the primary effectiveness end point) was 35.8% per patient-year, as compared with 67.9% in the control group (hazard ratio, 0.53; p<0.001). 29.1% of the patients in the device group died from any cause, as compared with 46.1% in the control group (hazard ratio, 0.62; p<0.001). Freedom from device-related complications (the primary safety end point) was 96.6% (p<0.001 as compared with a performance goal).

Therefore, device-based treatment resulted in a significantly lower rate of hospitalization for heart failure and lower mortality, as compared to medical therapy alone. Furthermore, quality of life and functional capacity was improved. Freedom from device-related complications exceeded the pre-specified performance goal.

Original article: N Engl J Med 2018; 379:2307-2318

Author: Frederike Schmitz


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