MITRA-FR and COAPT : Why are the results so different and what are the consequences for the daily routine?

Abstract

Percutaneous mitral valve repair with the MitraClip in the COAPT study significantly reduced overall mortality and hospitalization in patients with at least moderate to severe mitral valve regurgitation, in comparison to guideline-compliant drug treatment alone. Consequently, the assumption that secondary mitral regurgitation is more a consequence than the cause of systolic heart failure needs to be revised; however, data from the simultaneously published MITRA-FR study showed no prognostic benefits for patients with advanced heart failure and severely enlarged left ventricle; therefore, MitraClip treatment should only be performed after careful patient selection and heart team decision. With respect to future patient selection further studies are needed to better define cut-offs for treatment or exclusion criteria and to identify patients who profit the most from treatment. Also, new catheter-based techniques and alternative approaches to treat functional mitral regurgitation need to be investigated.