Transcatheter mitral valve repair in heart failure patients significantly reduces hospitalizations and improves survival
Transcatheter mitral valve repair for heart failure patients with mitral regurgitation can reduce the long-term rate of hospitalizations by almost 50 percent, and death by nearly 30 percent, compared with heart failure patients who don’t undergo the minimally invasive procedure.
These are the findings from a new study led by a researcher from the Icahn School of Medicine at Mount Sinai. This multi-center trial is one of the largest trial to examine the safety and effectiveness of transcatheter mitral-valve repair in a heart failure population using Abbott’s MitraClip system. It shows this treatment option significantly improves outcomes for patients with heart failure that do not respond to conventional treatments.
The five-year results from the “Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Device” study, or COAPT, were announced Sunday, March 5, in a Late Breaking Clinical Trial presentation at the American College of Cardiology Scientific Sessions Together with World Congress of Cardiology (ACC.23/WCC) in New Orleans and published in The New England Journal of Medicine.
In the COAPT study, researchers investigated whether treating the severe secondary mitral valve regurgitation with TEER, which has no direct effect on the underlying weakened heart muscle, would improve overall outcomes in heart failure patients beyond medical therapy alone. The two-year results, published in 2018, showed for the first time that treating secondary mitral valve regurgitation improved patients’ symptoms, reduced hospitalizations, and led them to live longer. Their latest five-year results show further significant findings.
Researchers analyzed 614 patients enrolled between December 27, 2012, and June 23, 2017, at 78 sites in the United States and Canada. All patients had cardiomyopathy and secondary, severe mitral valve regurgitation despite treatment with optimal medical therapy for heart failure. Half of those patients continued their heart failure medication, while the other half underwent transcatheter valve repair with the MitraClip while continuing on the heart failure medication. Over the five years following treatment, the yearly rates of heart failure hospitalizations were 33.1 percent in the MitraClip group compared to 57.2 percent with patients treated with medications only, which was a 47 percent reduction. Deaths from heart failure were reduced by 29 percent in the MitraClip group compared with patients treated with medications only, and all-cause death was reduced by 28 percent.
Even though patients in the MitraClip group had fewer deaths and hospitalizations after successful treatment, at the end of five years, 73.6 percent of them died or had one or more heart failure hospitalizations (compared to 91.5 percent of patients in the medication-only group).
