TY  - BOOK
AU  - Weissman, Neil J
TI  - Transcatheter Mitral-Valve Repair in Patients with Heart Failure
SN  - 0028-4793
PY  - 2018///
KW  - *Heart Valve Prosthesis Implantation
KW  - *Mitral Valve Insufficiency/su [Surgery]
KW  - Aged
KW  - Aged, 80 and over
KW  - Combined Modality Therapy
KW  - Female
KW  - Heart Failure/et [Etiology]
KW  - Heart Failure/mo [Mortality]
KW  - Heart Failure/su [Surgery]
KW  - Heart Valve Prosthesis Implantation/ae [Adverse Effects]
KW  - Heart Valve Prosthesis/ae [Adverse Effects]
KW  - Hospitalization/sn [Statistics & Numerical Data]
KW  - Humans
KW  - Intention to Treat Analysis
KW  - Kaplan-Meier Estimate
KW  - Male
KW  - Middle Aged
KW  - Mitral Valve Insufficiency/dt [Drug Therapy]
KW  - Mitral Valve Insufficiency/mo [Mortality]
KW  - Mitral Valve/su [Surgery]
KW  - Percutaneous Coronary Intervention
KW  - Prosthesis Failure
KW  - Stroke Volume
KW  - Treatment Outcome
KW  - Ventricular Dysfunction, Left/et [Etiology]=790  \\
KW  - Stone GW
KW  - MedStar Heart & Vascular Institute
KW  - Journal Article
N1  - Available online from MWHC library: 1993 - present, Available in print through MWHC library: 1980 - present
N2  - BACKGROUND: Among patients with heart failure who have mitral regurgitation due to left ventricular dysfunction, the prognosis is poor. Transcatheter mitral-valve repair may improve their clinical outcomes; CONCLUSIONS: Among patients with heart failure and moderate-to-severe or severe secondary mitral regurgitation who remained symptomatic despite the use of maximal doses of guideline-directed medical therapy, transcatheter mitral-valve repair resulted in a lower rate of hospitalization for heart failure and lower all-cause mortality within 24 months of follow-up than medical therapy alone. The rate of freedom from device-related complications exceeded a prespecified safety threshold. (Funded by Abbott; COAPT ClinicalTrials.gov number, NCT01626079 .); METHODS: At 78 sites in the United States and Canada, we enrolled patients with heart failure and moderate-to-severe or severe secondary mitral regurgitation who remained symptomatic despite the use of maximal doses of guideline-directed medical therapy. Patients were randomly assigned to transcatheter mitral-valve repair plus medical therapy (device group) or medical therapy alone (control group). The primary effectiveness end point was all hospitalizations for heart failure within 24 months of follow-up. The primary safety end point was freedom from device-related complications at 12 months; the rate for this end point was compared with a prespecified objective performance goal of 88.0%; RESULTS: Of the 614 patients who were enrolled in the trial, 302 were assigned to the device group and 312 to the control group. The annualized rate of all hospitalizations for heart failure within 24 months was 35.8% per patient-year in the device group as compared with 67.9% per patient-year in the control group (hazard ratio, 0.53; 95% confidence interval [CI], 0.40 to 0.70; P<0.001). The rate of freedom from device-related complications at 12 months was 96.6% (lower 95% confidence limit, 94.8%; P<0.001 for comparison with the performance goal). Death from any cause within 24 months occurred in 29.1% of the patients in the device group as compared with 46.1% in the control group (hazard ratio, 0.62; 95% CI, 0.46 to 0.82; P<0.001)
UR  - https://dx.doi.org/10.1056/NEJMoa1806640
ER  -