🎙️ Episode 36: Mitral Valve 2.0: Transcatheter Repair Steps Up

🧪 Trials:

RESHAPE-HF2: ↓ HF hospitalizations with transcatheter edge-to-edge repair vs medical therapy.

MATTR: Transcatheter approach non-inferior to surgical repair.

🧩 Clinical Takeaway:

Game-changing for patients too high risk for surgery.

Less peri-op risk, faster recovery — mitral repair is heading the way of TAVR.

Transcript

Intro to Transcatheter Mitral Repair

Speaker 1 0:01

All right , let's talk about transcatheter mitral valve repair . Now , this would sound impossible 10 years ago , but if you follow the progress of cavers and watch how they've just expanded , you would know this is happening . The mitral valve is probably one of the more complex of the valves . Now remember it gets that name the mitral . It's kind of a hat , a weird bishop's hat

Complexity of Mitral Valve

Speaker 1 0:25

. You can type in weird bishop's hat and type in mitral and you'll see what I'm talking about . It's like a sail , very difficult to repair . It's one of those ones that's harder to take care of and there's been more trials and as the technology gets better and better , I think transcatheter is going to be the way to go in the future , just a matter of time . So we're talking about two trials the reshape heart failure , reshape , hf2 , which is transcatheter edge-to-edge repair , to medical therapy alone . You say why would they

Reshape HF2 Trial Results

Speaker 1 1:00

do medical therapy ? Because these patients did not qualify . They were too sick , basically , or had too many other medical problems to qualify for getting a surgical mitral valve repair . And this patient had 505 patients , mean age is 70 . Okay , they had symptomatic heart failure and moderate to severe functional mitral regurgitation in which isolated surgery was not recommended at that time . So between medical therapy and injury there was no difference in mortality . This is a big thing . So no difference in mortality . But the transcatheter edge-to-edge repair outperformed medical therapy alone in first or recurrent hospitalizations for heart failure or cardiovascular death . So less admissions . Also a mean improvement in the Kansas City Cardiomyopathy Questionnaire scores and they felt better . So they felt better and didn't go to the hospital as much . Now the big thing is there was no change in death . Okay , and so these are things that we'll move along as we get better and better at these .

Speaker 1 2:04

Now the Manahorn study was to transcatheter edge-edge repair to surgical mitral repair Just 208 patients , mean age of 71 , and they had

Manahorn Study Findings

Speaker 1 2:14

severe mitral regurgitation . The one-year rate of death , heart failure hospitalization , mitral valve re-intervention meaning they had to go back and repair left ventricle assist device implantation and stroke , uh criteria met for non-inferiority okay , so was not inferior . But the major reverse events at 30 days was less frequent with transcatheter edge edge repair was significant , 15 percent versus 35 percent . There was no difference in six minute walk time and ah , new york hospital association heart , new york heart association class , or change in the missoula living with heart failure score . But this is a start and this is where we think of this is where things are going to start changing , where mitral valve repair will be more of a transcatheter and we can imagine

Future Implications for Heart Treatment

Speaker 1 3:06

a day when TAVR will be taking over instead of an open heart or an open surgery .