Managing Mitral Regurgitation in Heart Failure-Perspectives After COAPT.

Abstract

Functional mitral regurgitation (MR) in setting of cardiomyopathy causes significant morbidity and worsened survival. Surgical therapies have failed to demonstrate significant overall benefit for functional MR. More recently, major trials utilizing transcatheter therapies for functional MR have been completed and offer new avenues for intervention. This review evaluates and compares 2 major recent trials designed to test the benefit of edge-to-edge repair using the MitraClip system for severe functional MR. The Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients with Functional Mitral Regurgitation (COAPT) and Percutaneous Repair with the MitraClip Device for Severe Functional/Secondary Mitral Regurgitation (MITRA-FR) trials were simultaneous trials evaluating the treatment of effect of MitraClip in the setting of severe functional mitral regurgitation. Results of the trials were quite different with COAPT demonstrating substantial clinical benefit including significantly improved survival compared with MITRA-FR in which no clinical benefit was derived. Key differences in the patient population between the COAPT and MITRA-FR trials help to explain the contrasting results between the 2 trials designed to test the same hypothesis. Patients in COAPT had higher severity of MR with less dilated ventricles compared with MITRA-FR. These results will help shape patient selection for who will most benefit from MitraClip therapy. Further transcather mitral valve therapies continue to evolve and will likely offer alternative therapies for MR as technology improves.