Randomised trials in mitral transcatheter edge-to-edge repair: taking yet another look

Annual volumes of mitral transcatheter edge-to-edge repair (M-TEER) procedures as well as the number of centres performing this in Europe are increasing1. Based on data from three randomised clinical trials, the recently published European Society of Cardiology/European Association for Cardio-Thoracic Surgery (ESC/EACTS) Guidelines for the management of valvular heart disease have provided a revised Class I recommendation for M-TEER in patients with severe ventricular functional mitral regurgitation (FMR) without concomitant coronary artery disease (CAD) if symptoms persist despite optimised guideline-directed heart failure therapy2. However, apart from guideline recommendations, the spectrum of patients with ventricular FMR in everyday practice is broad, and there is still often substantial debate in multidisciplinary Heart Teams on when to apply M-TEER, in whom to apply it, and what results to expect.

Right after release of the most recently published RESHAPE-HF2 trial3, Markus Anker and colleagues presented a study-level meta-analysis to synthesise data from RESHAPE-HF2 with those from the previously published COAPT and MITRA-FR trials4. Their analysis suggested substantial between-trial heterogeneity and concluded that the benefit of M-TEER in addition to optimised guideline-directed...