Photo Credit: Miralex

The following is a summary of “Repeat Mitral Valve Interventions After Transcatheter Edge-to-Edge Repair: The COAPT Trial,” published in the May 2024 issue of Cardiology by Shahim et al.

The frequency and effectiveness of repeat mitral valve interventions (RMVI) after transcatheter edge-to-edge repair (TEER) for secondary mitral regurgitation (MR) are unknown.

Researchers conducted a retrospective study examining the rate of and outcomes following RMVI after TEER in the COAPT trial.

They used the COAPT trial and randomized patients with heart failure (HF) and severe secondary MR to TEER with the MitraClipTM device plus guideline-directed medical therapy (GDMT) vs. GDMT alone. They also evaluated the characteristics and outcomes of patients with an RMVI during a 4-year follow-up.

The results showed 293 patients randomized to TEER+GDMT, and 10 patients underwent RMVI after 4 years of follow-up, with an incidence of 3.90%, 95% CI 2.08-7.08, mean 182 days after the initial procedure. Patients who underwent RMVI had larger mitral annular diameters and lesser clips and were likely to have ≥3+ MR at discharge. Reasons included failed index procedure (difficult transseptal picture [n=2] or tamponade [n=1]), residual or recurrent severe MR (n=5), partial clip detachment (n=1), and site-assessed mitral stenosis (n=1). The RMVI was successful in 80% of patients and had higher 4-year rates of HF hospitalization (HFH) but similar mortality compared to those without RMVI. The incidence rates of HFH in patients opting for RMVI were 234 events per 100 person-years (95% CI 139-395) pre-RMVI and 46 per 100 person-years (95% CI 25-86) after RMVI, while patients not undergoing RMVI had an event rate of 32 per 100 patient-years (95% CI 28-36). The rate of HFH reduced after RMVI (0.20, 95% CI 0.09-0.45).

Investigators concluded that RMVI after TEER in the COAPT trial showed promising results in reducing HF hospitalization rates, indicating its potential benefit in managing secondary MR.

Source: ajconline.org/article/S0002-9149(24)00395-3/abstract#%20