[Türkçe]

Turkish Society of Cardiology Young Cardiologists Bulletin Year: 7 Number: 5 / 2024


Turkish Society of Cardiology
Young Cardiologists
President
Dr. Muzaffer Değertekin

Coordinator for the
Board of Directors

Dr. Ertuğrul Okuyan

Coordinator for the
Board of Directors

Dr. Can Yücel Karabay

Members
Dr. Adem Aktan
Dr. Gülşah Aktüre
Dr. Bayram Arslan
Dr. İnanç Artaç
Dr. Ahmet Oğuz Aslan
Dr. Görkem Ayhan
Dr. Ahmet Anıl Başkurt
Dr. Özkan Bekler
Dr. Oğuzhan Birdal
Dr. Yusuf Bozkurt Şahin
Dr. Serkan Bulgurluoğlu
Dr. Ümit Bulut
Dr. Veysi Can
Dr. Mustafa Candemir
Dr. Murat Çap
Dr. Göksel Çinier
Dr. Ali Çoner
Dr. Yusuf Demir
Dr. Ömer Furkan Demir
Dr. Murat Demirci
Dr. Ayşe İrem Demirtola Mammadli
Dr. Süleyman Çağan Efe
Dr. Mehmet Akif Erdöl
Dr. Kubilay Erselcan
Dr. Kerim Esenboğa
Dr. Duygu Genç
Dr. Kemal Göçer
Dr. Elif Güçlü
Dr. Arda Güler
Dr. Duygu İnan
Dr. Hasan Burak İşleyen
Dr. Muzaffer Kahyaoğlu
Dr. Sedat Kalkan
Dr. Yücel Kanal
Dr. Özkan Karaca
Dr. Ahmet Karaduman
Dr. Mustafa Karanfil
Dr. Ayhan Kol
Dr. Fatma Köksal
Dr. Mevlüt Serdar Kuyumcu
Dr. Yunus Emre Özbebek
Dr. Ahmet Özderya
Dr. Yasin Özen
Dr. Ayşenur Özkaya İbiş
Dr. Çağlar Özmen
Dr. Selvi Öztaş
Dr. Hasan Sarı
Dr. Serkan Sivri
Dr. Ali Uğur Soysal
Dr. Hüseyin Tezcan
Dr. Nazlı Turan
Dr. Berat Uğuz
Dr. Örsan Deniz Urgun
Dr. İdris Yakut
Dr. Mustafa Yenerçağ
Dr. Mehmet Fatih Yılmaz
Dr. Yakup Yiğit
Dr. Mehmet Murat Yiğitbaşı

Bulletin Editors
Dr. Muzaffer Değertekin
Dr. Can Yücel Karabay
Dr. Muzaffer Kahyaoğlu
Dr. Ahmet Karaduman

Contributors
Dr. Ahmet Karaduman
Dr. Berkant Öztürk
Dr. Burak Kardeşler
Dr. Kıvanç Eren
Dr. Mehmet Aydoğan
Dr. Murat Demirci
Dr. Murat Yiğitbaşı
Dr. Mustafa Candemir
Dr. Mustafa Lütfi Yavuz
Dr. Mustafa Yenerçağ
Dr. Ravza Betül Akbaş
Dr. Selvi Öztaş
Dr. Serkan Bulgurluoğlu
Dr. Yunus Çalapkulu
Dr. Yusuf Bozkurt 


 



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MATTERHORN trial- Transcatheter versus surgical mitral valve repair in patients with heart failure and secondary mitral regurgitationTürk Kardiyoloji Derneği Genç Kardiyologlar Bülteni - MATTERHORN trial- Transcatheter versus surgical mitral valve repair in patients with heart failure and secondary mitral regurgitation (Dr. Ravza Betül AKBAŞ)

Dr. Ravza Betül Akbaş

Name of the Study: MATTERHORN trial- Transcatheter versus surgical mitral valve repair in patients with heart failure and secondary mitral regurgitation

Published in Congress: ESC 2024

Link: Full text

https://www.nejm.org/doi/abs/10.1056/NEJMoa2408739

Background:

Current guidelines recommend mitral valve surgery and transcatheter edge-to-edge mitral valve repair for patients with secondary mitral regurgitation and heart failure. However, the number of randomized studies comparing these two interventions in this patient population is insufficient.

Objective:

The MATTERHORN study evaluated whether transcatheter edge-to-edge repair is non-inferior to mitral valve surgery in patients with secondary mitral regurgitation who are at high surgical risk.

Methods:

This study, a non-inferiority trial, was designed as a randomized, prospective study conducted across 16 centers in Germany. It aimed to compare transcatheter edge-to-edge repair (intervention group) with surgical mitral valve repair or replacement (surgical group) in heart failure patients with secondary mitral regurgitation who remained symptomatic despite optimal medical therapy. Patients were included if they met the criteria of having clinically significant secondary mitral regurgitation parameters on echocardiography or if they had been hospitalized at least twice in the past year for acute heart failure. Additionally, patients were required to have a left ventricular ejection fraction of at least 20% and to be in NYHA class 2 or higher despite optimal medical therapy. Patients with other significant valvular diseases or those who had undergone coronary revascularization within the past month were excluded from the study.

The primary endpoint was defined as a composite of death, heart failure-related hospitalization, mitral valve re-intervention, assist device implantation, and stroke within one year following the procedure. The primary safety endpoint was the composite of major adverse events occurring within 30 days after the procedure.

Results:

A total of 210 patients were randomized in the study. The mean age of the patients was 70.5±7.9 years, with a left ventricular ejection fraction of 43%±11.7, and 39.9% of the patients were female. Within one year, the incidence of experiencing at least one component of the primary endpoint was 16.7% in the intervention group compared to 22.5% in the surgical group, confirming non-inferiority with a p-value of <0.001. The primary safety endpoint events occurred in 14.9% of the patients in the intervention group, compared to 54.8% in the surgical group (p<0.001).

Conclusion:

In heart failure patients with secondary mitral regurgitation, transcatheter edge-to-edge mitral valve repair is non-inferior to mitral valve surgery regarding the composite outcomes of death, recurrent heart failure hospitalizations, stroke, re-intervention on the valve, or assist device implantation. Additionally, it offers certain safety advantages.

Interpretations:

European guidelines recommend transcatheter intervention for secondary mitral regurgitation only in patients who are not suitable for surgery, whereas American guidelines suggest surgical intervention only for patients who are anatomically unsuitable for transcatheter repair. This study may assist in guiding treatment decisions by providing insights into the safety outcomes of transcatheter edge-to-edge mitral valve repair compared to mitral valve surgery.


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