Photo Credit: Shidlovski

In the MATTERHORN trial, transcatheter edge-to-edge repair (TEER) was found to be as effective as surgery for treating patients with secondary mitral regurgitation. TEER had a better safety profile than surgical intervention.

Volker Rudolph, MD, PhD, from the Heart and Diabetes Center NRW, in Bad Oeynhausen, Germany presented the results of the single-center MATTERHORN non-inferiority trial (NCT02371512), which was simultaneously published in the New England Journal of Medicine^1,2. This trial aimed to offer critical insights for clinicians managing patients with heart failure (HF) and secondary mitral regurgitation. It compared the effectiveness and safety of TEER with traditional surgical mitral-valve repair or replacement in patients who remained symptomatic despite receiving guideline-directed medical therapy.

The trial randomly assigned participants (n=210; average age of 70.5 years; 39.9% women) to undergo TEER or mitral-valve surgery in a 1:1 ratio. The primary efficacy endpoint was a composite of death, HF hospitalization, mitral-valve reintervention, assist device implantation, or stroke within 1 year. The primary safety endpoint evaluated major AEs within 30 days post-procedure.

After 1 year, the composite efficacy endpoint was reached by 16.7% of participants in the TEER group compared with 22.5% in the surgery group (mean difference: -6 percentage points; 95% CI -17 to 6; P<0.001 for non-inferiority). In terms of safety, the TEER group experienced significantly fewer major AEs within 30 days, with only 14.9% affected versus 54.8% in the surgery group (mean difference: -40 percentage points; 95% CI -51 to -27; P<0.001).

One peculiarity of this trial is the lack of a medical treatment arm. By not having a medical therapy arm, the investigators assume that any intervention is superior to none. Nevertheless, the study concluded that TEER is non-inferior to mitral-valve surgery for patients with HF and secondary mitral regurgitation, offering a less invasive alternative with a significantly better safety profile. These findings may influence future treatment guidelines, providing an evidence-based option for patients who are unsuitable or at high risk for surgery.