Shadows and light in transcatheter mitral valve treatment: recent evidence and implications for clinical practice

Functional mitral regurgitation (FMR) remains a significant challenge in the management of heart failure (HF), characterised by poor prognosis and high morbidity.1 As the predominant valvular complication in HF, FMR exacerbates haemodynamic burden, contributing to progressive ventricular dysfunction and increased mortality. The advent of transcatheter edge-to-edge repair (TEER) has introduced a minimally invasive option for managing FMR, particularly in high-risk patients unsuitable for surgery. The recently presented findings from the MATTERHORN2 and RESHAPE-HF23 trials at the 2024 ESC Congress provide crucial insights into the efficacy and safety of TEER, advancing our understanding of its clinical utility. This review examines these pivotal trials, incorporates insights from COAPT4 and MITRA-FR5, discusses surgical approaches and offers recommendations for integrating TEER into clinical practice.