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No benefit of percutaneous reduction of secondary mitral regurgitation in HF patients over standard care

Prof. Jean-Francois Obadia, Civil Hospices of Lyon, France
ESC 2019
Two-year results of the MITRA-FR trial confirm that the addition of percutaneous clip to medical treatment did not decrease the rate of death or unplanned hospitalisation for heart failure (HF). Although researchers noted that they observed trends in subgroup or post-hoc analysis, the lack of power limits the relevance of such analysis. Therefore, longer follow-up is needed as well as a meta-analysis on individual data.

Until recently, the evidence on the efficacy of percutaneous correction of secondary mitral regurgitation in HF patients, mainly based on two studies, was conflicting [1,2]. As longer duration of one of the trials may be an influencing factor, a 2-year follow-up of patients in MITRA-FR was set up. Primary objective of the study was efficacy and safety of percutaneous mitral valve repair in patients with HF and severe secondary mitral regurgitation. Primary endpoint of the study was the composite of all-cause death or first unplanned rehospitalisation for HF.

At 24 months, 63.8% of patients who underwent valve repair and 67.1% of those who did achieved the primary endpoint (no significant difference). When these outcomes were analysed separately, no significance was seen either. All-cause mortality was 34.9% in the intervention arm and 34.2% in the control arm. Unplanned hospitalisation for HF occurred in 55.9% and 61.8% in the intervention and control groups, respectively. Interestingly, when events occurring between 12 and 24 months were analysed, a lower rate emerged for first hospitalisation for HF in the intervention group, which was consistent with a divergence in the curves of recurrent hospitalisations for HF for each group.

Prof. Jean-Francois Obadia (Civil Hospices of Lyon, France) warned that this finding should be viewed with caution and no conclusions can be drawn from it. “In fact, what we do gather from this –and previous studies on the condition– is that more knowledge is needed to understand secondary mitral regurgitation, as there are still many undiscovered areas concerning this disease” [3].

1. Obadia JF, et al. [N Engl J Med. 2018;379:2297-2306](https://www.nejm.org/doi/full/10.1056/NEJMoa1805374%5d).
2. Stone GW, et al. [N Engl J Med. 2018;379:2307-2318](https://www.nejm.org/doi/full/10.1056/NEJMoa1806640).
3. Obadia JF. MITRA-FR - 2 years follow-Up of the MITRA-FR study a randomized controlled trial evaluating the effectiveness of percutaneous mitral valve repair in secondary mitral regurgitation. FP Number 4200. ESC Congress 2019, 31 Aug-4 Sept, Paris, France.

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