Five-Year Follow-up after Transcatheter Repair of Secondary Mitral Regurgitation

This randomized controlled trial (COAPT) evaluated long-term outcomes of transcatheter edge-to-edge repair (MitraClip) for patients with heart failure and moderate-to-severe or severe secondary mitral regurgitation. Among 614 participants randomized to device therapy or guideline-directed medical therapy alone, transcatheter repair significantly reduced heart failure hospitalizations (annualized rate 33.1% vs. 57.2%; HR 0.53) and all-cause mortality at 5 years (57.3% vs. 67.2%; HR 0.72). The composite of death or heart failure hospitalization occurred in 73.6% of the device group vs. 91.5% of the control group (HR 0.53). Safety profile was favorable, with device-specific events in only 1.4% of patients, all within 30 days post-procedure. Benefits were consistent across subgroups and maintained despite protocol-permitted crossover from control to device therapy. Findings confirm the durable benefit and safety of MitraClip in appropriately selected patients unresponsive to medical therapy.

This randomized controlled trial (COAPT) evaluated long-term outcomes of transcatheter edge-to-edge repair (MitraClip) for patients with heart failure and moderate-to-severe or severe secondary mitral regurgitation. Among 614 participants randomized to device therapy or guideline-directed medical therapy alone, transcatheter repair significantly reduced heart failure hospitalizations (annualized rate 33.1% vs. 57.2%; HR 0.53) and all-cause mortality at 5 years (57.3% vs. 67.2%; HR 0.72). The composite of death or heart failure hospitalization occurred in 73.6% of the device group vs. 91.5% of the control group (HR 0.53). Safety profile was favorable, with device-specific events in only 1.4% of patients, all within 30 days post-procedure. Benefits were consistent across subgroups and maintained despite protocol-permitted crossover from control to device therapy. Findings confirm the durable benefit and safety of MitraClip in appropriately selected patients unresponsive to medical therapy.