🎙️ 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.

Chapters

• 0:00 Intro to Transcatheter Mitral Repair
• 0:35 Complexity of Mitral Valve
• 1:10 Reshape HF2 Trial Results
• 2:24 Manahorn Study Findings
• 3:16 Future Implications for Heart Treatment

Transcript

Speaker 1: 0:11

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. 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 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: 2:14

Now the Manahorn study was to transcatheter edge-edge repair to surgical mitral repair Just 208 patients, mean age of 71, and they had 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 a day when TAVR will be taking over instead of an open heart or an open surgery.