MATTERHORN: Transcatheter repair matches surgery for HF with secondary mitral regurgitation

In the MATTERHORN trial, transcatheter edge-to-edge repair (TEER) was found to be as effective as surgery for treating patients with secondary mitral regurgitation. TEER had a better safety profile than surgical intervention.

Prof. Volker Rudolph (Heart and Diabetes Center NRW, Bad Oeynhausen, Germany) presented the results of the single-centre, non-inferiority MATTERHORN trial (NCT02371512), which were simultaneously published in the New England Journal of Medicine [1,2]. This trial aimed to offer critical insights for clinicians managing patients with heart failure (HF) and secondary mitral regurgitation. It compared the effectiveness and safety of TEER with traditional surgical mitral-valve repair or replacement in patients who remained symptomatic despite receiving guideline-directed medical therapy.

The trial randomly assigned participants (n=210; average age of 70.5 years; 39.9% women) to undergo TEER or mitral-valve surgery in a 1:1 ratio. The primary efficacy endpoint was a composite of death, HF hospitalisation, mitral-valve reintervention, assist device implantation, or stroke within 1 year. The primary safety endpoint evaluated major adverse events within 30 days post-procedure.

After 1 year, the composite efficacy endpoint was reached by 16.7% of participants in the TEER group compared with 22.5% in the surgery group (mean difference -6 percentage points; 95% CI -17 to 6; P_{non-inferiority}<0.001). In terms of safety, the TEER group experienced significantly fewer major adverse events within 30 days, with only 14.9% affected versus 54.8% in the surgery group (mean difference -40 percentage points; 95% CI -51 to -27; P<0.001).

One peculiarity of this trial is the lack of a medical treatment arm. By not having a medical therapy arm, the investigators assume that any intervention is superior to none. Nevertheless, the study concluded that TEER is non-inferior to mitral-valve surgery for patients with HF and secondary mitral regurgitation, offering a less invasive alternative with a significantly better safety profile. These findings may influence future treatment guidelines, providing an evidence-based option for patients who are unsuitable or at high risk for surgery.

1. 
   
   1. Rudolph V, et al. MATTERHORN – Transcatheter versus surgical mitral valve repair in patients with heart failure and secondary mitral regurgitation. HOTLINE 3, ESC Congress 2024, 30 Aug–02 Sept, London, UK.
   2. Baldus S, et al. N Engl J Med 2024; 31 Aug. DOI: 10.1056/NEJMoa2408739.

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Posted on 7 November 20247 November 2024