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MitraClip: How Do We Reconcile the Inconsistent Findings of MITRA-FR and COAPT?

  • New Therapies for Cardiovascular Disease (AA Bavry, Section Editor)
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Abstract

Purpose of Review

Secondary mitral regurgitation (MR) is a common valvular disorder in patients with left ventricular (LV) dysfunction and is associated with worse morbidity and mortality. New data on percutaneous mitral valve (MV) repair suggest that targeting the valve itself may improve outcomes. Our objective is to review two recent trials (MITRA-FR and COAPT) with regard to percutaneous MV repair. We will dive into their methodology and results and propose potential explanations for their divergent outcomes.

Recent Findings

MITRA-FR and COAPT studied the MitraClip plus guideline-directed medical therapy (GDMT) versus GDMT alone in patients with secondary MR. COAPT found an overwhelming benefit in reduction in HF hospitalization and mortality whereas MITRA-FR found no difference between treatment groups. Patient selection, differences in procedural outcomes, and smaller LV dimensions may explain these diametrically opposed results.

Summary

Secondary MR is a common valvular disorder with complex pathophysiology. There are certain patients who will not benefit from percutaneous MV repair. The results of MITRA-FR and COAPT suggest that percutaneous MV repair may benefit carefully selected individuals with secondary MR on maximum tolerated doses of GDMT.

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  1. Division of Cardiology, University of Texas Southwestern Medical Center, 2001 Inwood Road Suite WC05.852, Dallas, TX, 75390-9254, USA

    Rina Mauricio & Dharam J. Kumbhani

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  1. Rina Mauricio
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Correspondence to Dharam J. Kumbhani.

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Rina Mauricio and Dharam J. Kumbhani declare that they have no conflict of interest.

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Mauricio, R., Kumbhani, D.J. MitraClip: How Do We Reconcile the Inconsistent Findings of MITRA-FR and COAPT?. Curr Cardiol Rep 21, 150 (2019). https://doi.org/10.1007/s11886-019-1239-0

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