The MATTERHORN trial, published in The New England Journal of Medicine, investigates the efficacy of transcatheter repair (M-TEER) versus surgical mitral-valve repair for secondary mitral regurgitation (MR) in patients with heart failure. This randomized controlled trial included 208 patients, equally divided between the intervention group (M-TEER) and the surgery group.
Key Findings:
- Primary Outcome: The composite outcome of death, heart failure (HF) hospitalization, stroke, valve reintervention, or assist device implantation at 1 year was 16.7% for the M-TEER group compared to 22.5% for the surgery group. The P-value for noninferiority was <0.001, indicating M-TEER was noninferior to surgery.
- Major Adverse Events: At 30 days post-procedure, major adverse events were significantly lower in the M-TEER group (14.9%) versus the surgery group (54.8%) (P < 0.001).
- Secondary Outcomes:
- Recurrence of grade 3+ or 4+ MR at 1 year was higher in the M-TEER group (8.9%) compared to the surgery group (1.5%), with a noninferiority P-value of 0.02.
- All-cause mortality at 1 year was 8.1% in the M-TEER group versus 11.2% in the surgery group.
Conclusion:
Among patients with heart failure and secondary MR, M-TEER demonstrated noninferiority to surgery with respect to a composite of death, rehospitalization for heart failure, stroke, reintervention, or assist device implantation at 1 year. M-TEER also showed a significantly lower rate of major adverse events within 30 days post-procedure, although it was associated with a slightly higher recurrence of MR at 1 year.
This trial highlights the potential of M-TEER as a less invasive yet effective alternative to surgery for patients with secondary mitral regurgitation, particularly in reducing early procedural risks.
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