TMVR boosts survival, cuts hospitalization in heart failure patients

Transcatheter mitral valve repair (TMVR) is safe, provides a durable reduction in mitral regurgitation (MR), reduces rate of heart failure (HF) hospitalization, and improves survival, quality of life, and functional capacity in patients with HF and moderate-to-severe or severe MR who remained symptomatic despite guideline-directed medical therapy (GDMT), a study has shown.

“Surviving patients who crossed over to device treatment had a prognosis comparable to those originally assigned to transcatheter therapy,” the authors said.

A total of 614 HF patients with moderate-to-severe or severe secondary MR, who remained symptomatic despite maximally tolerated GDMT, were randomized to TMVR plus GDMT or GDMT alone. HF hospitalizations through 24-month follow-up was the primary endpoint. Patients were followed for 36 months.

The annualized rate of HF hospitalizations per patient-year was lower in the TMVR group relative to the GDMT alone group (35.5 percent vs 68.8 percent; hazard ratio [HR], 0.49, 95 percent confidence interval [CI], 0.37–0.63; p<0.001; number needed to treat [NNT], 3.0, 95 percent CI, 2.4–4.0).

Mortality rate was also lower in the device group compared to the control group (42.8 percent vs 55.5 percent; HR, 0.67, 95 percent CI, 0.52–0.85; p=0.001; NNT, 7.9, 95 percent CI, 4.6–26.1). In addition, patients who underwent TMVR had sustained 3-year improvements in MR severity, quality of life measures, and functional capacity.

The subsequent composite rate of mortality of HR hospitalization also decreased in 58 patients assigned to GDMT alone who crossed over and were treated with TMVR as opposed to those who continued on GDMT alone (adjusted HR, 0.43, 95 percent CI, 0.24–0.78; p=0.006).