Valvular & structural heart disease
Transcatheter edge-to-edge repair plus guideline-directed medical therapy versus guideline-directed medical therapy alone for symptomatic functional mitral regurgitation: a comprehensive, up-to-date meta-analysis of randomised trials
Authors' conclusion
In symptomatic moderate-to-severe FMR, TEER plus GDMT significantly reduces death or hospitalisation due to heart failure and hospitalisation due to heart failure at 24 months.
Study context
- Population
- Patients with symptomatic moderate-to-severe functional mitral regurgitation (FMR)Three randomised trials (MITRA-FR, COAPT, and RESHAPE-HF2)
- Participants
- 1,422 patients
- Comparison
- Transcatheter edge-to-edge repair (TEER) plus guideline-directed medical therapy (GDMT) with GDMT alone in FMR
- TEER plus GDMTn = 703
- GDMT alonen = 719reference
- Outcome
- Death or first hospitalisation due to heart failure
- Follow-up
- 24 months
Methodological detailsreconstructed time-to-first event individual patient data, mixed-effects Cox models, random-effects models based on study-level data
- Reconstructed time-to-first event individual patient data
- Mixed-effects Cox models
- Random-effects models based on study-level data
Pooled result
As reported in the abstract
TEER plus GDMT vs GDMT aloneHazard ratio (95% CI)P value
One-stage analysis
0.72(0.56–0.92)
P = 0.010Two-stage analysis
0.72(0.51–1.00)
P = 0.052Further pooled results
| Outcome | HR (95% CI) | P value | |
|---|---|---|---|
| First hospitalisation due to heart failure (key secondary outcome) · 24 monthsTEER plus GDMTvs GDMT aloneOne-stage | 0.65 (0.48–0.88) | P = 0.006 | |
| First hospitalisation due to heart failure (key secondary outcome) · 24 monthsTEER plus GDMTvs GDMT aloneTwo-stage | 0.66 (0.45–0.96) | P = 0.031 | |
| 0.512Hazard ratio (log scale) |
- First hospitalisation due to heart failure (key secondary outcome): heterogeneity I²=81.2%; p=0.005
All-cause death and cardiovascular death · 24 months
- Not significantly different between treatment groups but became significant after excluding MITRA-FR in the leave-one-out analysis
Original publication
Transcatheter edge-to-edge repair plus guideline-directed medical therapy versus guideline-directed medical therapy alone for symptomatic functional mitral regurgitation: a comprehensive, up-to-date meta-analysis of randomised trials. EuroIntervention. Published 19 January 2026. doi:10.
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