The MATTERHORN trial: Percutaneous MitraClip vs surgical repair in heart-failure-related secondary mitral regurgitation

Abstract

Introduction: Functional mitral regurgitation (FMR) is a common complication of heart failure and is associated with poor prognosis and increased morbidity and mortality. Surgical mitral valve repair (MVRe) and MitraClip transcatheter edge-to-edge repair (M-TEER) are used to improve FMR, however, there has not been sufficient comparison between the benefits of both approaches. The MATTERHORN trial aimed to compare the efficacy and safety outcomes of percutaneous versus surgical repair in high-risk patients with heart failure and FMR, to determine the noninferiority of transcatheter edge-to-edge therapy in this population.

Study and results: 208 patients were randomized in a 1:1 ratio to either M-TEER with MitraClip device or surgical mitral valve repair or replacement. The average age was 70.5±7.9 years, 39.9% were female, mean LVEF was 43.0 ±11.7%, 85.7% of patients had NYHA class III or IV, 96.0% had Mitral regurgitation grade 3, 38.2% had grade 4+, median effective regurgitant orifice area was 0.22cm² and the mean regurgitant fraction was 57.0±21.0%. Successful repair was seen in 96.1% in the M-TEER group and 98.6% in the surgery group. At 1 year, at least one primary endpoint event (death, hospitalizati... [see PDF for full Abstract]