09/02/2019 | Press release | Distributed by Public on 09/02/2019 09:13
Contribution To Literature:
The MITRA-FR trial failed to show that percutaneous mitral valve repair was superior to medical therapy at preventing adverse events.
The goal of the trial was to evaluate percutaneous mitral valve repair (MitraClip) compared with medical therapy among patients with severe functional mitral regurgitation.
Patients with severe secondary mitral regurgitation were randomized to percutaneous mitral valve repair (n = 152) versus medical therapy (n = 152). The results were the same among all tested subgroups.
Other salient features/characteristics:
The primary outcome, death or hospitalization for heart failure, occurred in 54.6% of the percutaneous mitral valve repair group compared with 51.3% of the medical therapy group (p = 0.53).
Among patients with severe secondary mitral regurgitation, percutaneous mitral regurgitation repair (MitraClip) was not beneficial. The MitraClip device was not associated with a reduction in the composite (or individual components) of death or hospitalization for heart failure. The MitraClip device was effective since 92% of patients experienced a reduction in mitral regurgitation of at least 2 grades; however, follow-up echocardiographic data were incompletely reported. The lack of benefit was likely due to the poor prognosis of the severe underlying cardiomyopathy.
This trial contrasts with the COAPT trial, which documented benefit from MitraClip therapy for secondary mitral regurgitation. One reason postulated for this difference is that patients in COAPT had more mitral regurgitation per unit of ventricular volume (i.e., disproportionate mitral regurgitation). In COAPT, the mean EROA was 41 mm2 and the mean LVEDV was 194 cc versus MITRA-FR, where the mean EROA was 31 mm2 and the mean LVEDV was 272 cc.
Presented by Dr. Jean-Francois Obadia at the European Society of Cardiology Congress, Paris, France, September 2, 2019.
Obadia JF, Messika-Zeitoun D, Leurent G, et al., on behalf of the MITRA-FR Investigators. Percutaneous Repair or Medical Treatment for Secondary Mitral Regurgitation. N Engl J Med 2018;379:2297-2306.
Editorial: Nishimura RA, Bonow RO. Percutaneous Repair of Secondary Mitral Regurgitation - A Tale of Two Trials. N Engl J Med 2018;379:2374-6.
Presented by Dr. Jean-Francois Obadia at the European Society of Cardiology Congress, Munich, Germany, August 27, 2018.
Clinical Topics:Cardiac Surgery, Geriatric Cardiology, Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Prevention, Valvular Heart Disease, Cardiac Surgery and Arrhythmias, Cardiac Surgery and Heart Failure, Cardiac Surgery and VHD, Acute Heart Failure, Interventions and Imaging, Interventions and Structural Heart Disease, Echocardiography/Ultrasound, Mitral Regurgitation
Keywords:ESC Congress, ESC 19, Cardiac Surgical Procedures, Cardiomyopathies, Echocardiography, Geriatrics, Heart Failure, Heart Valve Diseases, Mitral Valve Insufficiency, Primary Prevention, Stroke Volume