Transcatheter Edge-to-Edge Repair in 5,000 Patients With Secondary Mitral Regurgitation: COAPT Post-Approval Study.

BACKGROUND: Real-world applicability of the COAPT (Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients with Functional Mitral Regurgitation) randomized controlled trial (RCT) has been debated because of careful patient selection and the contrasting results of the MITRA-FR (Multicentre Study of Percutaneous Mitral Valve Repair MitraClip Device in Patients with Severe Secondary Mitral Regurgitation) RCT. OBJECTIVES: The COAPT-PAS (COAPT Post-Approval Study) was initiated to assess the safety and effectiveness of the MitraClip in patients with secondary mitral regurgitation (SMR). METHODS: COAPT-PAS is a prospective, single-arm, observational study of 5,000 consecutive patients with SMR treated with the MitraClip at 406 U.S. centers participating in the TVT (Transcatheter Valve Therapy) registry from 2019 to 2020. The 1-year outcomes from the COAPT-PAS full cohort and the COAPT-like and MITRA-FR-like subgroups who met RCT inclusion/exclusion criteria are reported. RESULTS: Patients in the COAPT-PAS had more comorbidities, more severe HF and functional limitations, and less guideline-directed medical therapy than those in the COAPT or MITRA-FR RCTs. Patients in the COAPT-PAS full cohort and the COAPT-like (n = 991) and MITRA-FR-like (n = 917) subgroups achieved a 97.7% MitraClip implant rate, a similar and durable reduction of mitral regurgitation to ≤2+ at 1 year (90.7%, 89.7%, and 86.6%, respectively), a large improvement in quality of life at 1 year (Kansas City Cardiomyopathy Questionnaire +29 COAPT-PAS, +27 COAPT-like, and +33 MITRA-FR-like), faster procedure times, similar or lower clinical event rates compared with the RCTs' MitraClip arms, and lower clinical event rates than the RCTs' guideline-directed medical therapy only arms. One-year heart failure hospitalizations was 18.9% in COAPT-PAS, 19.7% in COAPT-like compared with 24.9% in COAPT-RCT, and 28.7% in COAPT-PAS-MITRA-FR-like compared with 47.4% in MITRA-FR-RCT. CONCLUSIONS: This large, contemporary, real-world study reinforces the safety and effectiveness of the MitraClip System in patients with SMR, including those who met the COAPT or MITRA-FR RCT inclusion/exclusion criteria and patients excluded from the RCTs.

Initial experience with a magnetic navigation system for percutaneous coronary intervention in complex coronary artery lesions.

OBJECTIVES: The aim of this study was to evaluate the feasibility of a magnetic-assisted navigation system during percutaneous coronary intervention (PCI) of tortuous and severely angulated coronary arteries. BACKGROUND: The magnetic navigation system consists of two 0.8-T permanent magnets which generate a magnetic field over the heart. Altering the magnetic vector deflects a coronary guidewire with a magnetic tip. METHODS: Patients were selected for magnetic-assisted intervention (MAI) for potentially difficult to cross lesions. The time required for placement of the guidewire, total procedure time, fluoroscopy time, and amount of contrast for the procedure were recorded. There were a total of 59 patients undergoing PCI of 68 lesions. RESULTS: Patients were grouped based on whether MAI was attempted as a first option ("primary attempt"; n = 46) or following failure to pass a conventional guidewire ("secondary attempt"; n = 13). The target lesion was successfully crossed in 49 of 55 lesions (89%) and 9 of 13 lesions (69%) in patients undergoing primary and secondary attempts, respectively. The procedural success rates were 84% and 62%, respectively. Most lesions were located in the circumflex artery territory (39% and 62% of lesions, respectively). The median (25th and 75th percentiles) time for crossing the lesion was longer in the secondary attempt group (14.8 [5, 15.5] vs. 28.9 [8, 38] min). Median fluoroscopy time and median contrast used were also higher among the secondary attempt group. CONCLUSIONS: This first report of MAI suggests that it may become a useful adjunct for wire placement in difficult coronary interventions.