Transcatheter Mitral-Valve Repair Beats Medical Therapy in Patients with Heart Failure

Patients with heart failure (HF) and secondary mitral regurgitation (MR) have frequent hospitalizations and poor prognoses. Surgery, a class IIb guideline recommendation, is infrequently performed due to risk, a high recurrence rate with annuloplasty alone, and lack of demonstrated benefit. In the manufacturer-funded, randomized COAPT trial (NCT01626079), investigators compared transcatheter mitral repair with MitraClip plus guideline-directed medical therapy (GDMT) or GDMT alone in 614 patients with severe MR who were not appropriate for surgery (MR grades, 3+ or 4+; left ventricular ejection fraction, 20%–50%; mean effective regurgitant orifice area, EROA, 0.40 cm²). Patients were included only if they had remained symptomatic despite pre…