Transcatheter Repair of Secondary Mitral Regurgitation

This editorial evaluates 5-year results from the COAPT trial, which randomized 614 patients with heart failure and functional mitral regurgitation to transcatheter edge-to-edge mitral valve repair plus medical therapy, or medical therapy alone. Sustained reductions in heart failure hospitalization (33.1% vs. 57.2% per year; HR 0.53) and all-cause mortality (57.3% vs. 67.2%; HR 0.72) were observed, although effects attenuated after year 2 due to crossover. Valve function remained improved over time with low device complication rates. The editorial emphasizes that mitral regurgitation contributes to a pathophysiologic cycle beyond being a marker of disease severity. However, even after intervention, residual risk remains high. Underuse of guideline-recommended heart failure therapies was noted, especially sacubitril–valsartan (38.9% vs. 22.8%). Authors advocate optimizing medical therapy post-procedure and suggest it may eliminate the need for intervention in some patients. Emerging strategies such as resynchronization therapy, catheter ablation, and revascularization are discussed. The inclusion criteria from COAPT remain the current benchmark, pending results from trials like Reshape-HF2.

This editorial evaluates 5-year results from the COAPT trial, which randomized 614 patients with heart failure and functional mitral regurgitation to transcatheter edge-to-edge mitral valve repair plus medical therapy, or medical therapy alone. Sustained reductions in heart failure hospitalization (33.1% vs. 57.2% per year; HR 0.53) and all-cause mortality (57.3% vs. 67.2%; HR 0.72) were observed, although effects attenuated after year 2 due to crossover. Valve function remained improved over time with low device complication rates. The editorial emphasizes that mitral regurgitation contributes to a pathophysiologic cycle beyond being a marker of disease severity. However, even after intervention, residual risk remains high. Underuse of guideline-recommended heart failure therapies was noted, especially sacubitril–valsartan (38.9% vs. 22.8%). Authors advocate optimizing medical therapy post-procedure and suggest it may eliminate the need for intervention in some patients. Emerging strategies such as resynchronization therapy, catheter ablation, and revascularization are discussed. The inclusion criteria from COAPT remain the current benchmark, pending results from trials like Reshape-HF2.