Patient selection for transcatheter edge-to-edge mitral valve repair for severe functional mitral regurgitation

In 2018, two randomised clinical trials of transcatheter edge-to-edge mitral valve repair (TMVr) for functional mitral regurgitation (FMR) reported very different outcomes. The MITRA-FR trial showed no statistically significant difference in the combined endpoint of death or hospitalisation for heart failure (HF) at one year1. The COAPT trial showed marked improvements in total HF hospitalisations at two years, as well as mortality and multiple other pre-specified secondary endpoints2. We hypothesised that the divergent outcomes of the two trials could be explained largely by enrolment of different patient populations3. Patients in COAPT had a larger mean effective regurgitant orifice area (EROA) and ...