European Journal of Heart Failure expert consensus statement on transcatheter treatment of mitral regurgitation in heart failure

Sep 29, 2026

Uploaded by kopisore

Secondary mitral regurgitation (SMR) is common in heart failure and carries an adverse prognosis, with treatment typically beginning after guideline-directed pharmacotherapy and cardiac resynchronization therapy. Transcatheter mitral valve repair has improved in safety and efficacy, supported by new evidence from randomized trials including RESHAPE-HF2 and MATTERHORN. This expert consensus discusses updated indications across SMR subtypes, reviews the evidence base for transcatheter mitral valve repair, and positions the approach within the current SMR treatment hierarchy in heart failure.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages13

Reading Time33 min

AccessFree to download

Introduction

Pathophysiology

European Journal of Heart Failure (2025) 27, 2610–2622 POSITION PAPER doi:10.1002/ejhf.70043 European Journal of Heart Failure expert consensus statement on transcatheter treatment of mitral regurgitation in heart failure Christos Iliadis 1, Marianna Adamo2, Volker Rudolph3, Nicole Karam4, Ralph Stephan von Bardeleben5, Stefan D. Anker6, Victoria Delgado7, Jörg Hausleiter8,9, Hannah Kempton8, Marco Metra2, Michael Böhm 10, and Stephan Baldus 1* 1 Department of Internal Medicine III, Faculty of Medicine and University Hospital Cologne, University of Cologne, and Center for Cardiovascular Medicine (CCMABCD), partner site Cologne, Cologne, Germany; 2 Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy; 3 General and Interventional Cardiology, Heart and Diabetes Centre NRW, University Hospital of the Ruhr-University Bochum, Medical Faculty OWL, Bad Oeynhausen, Germany; 4 Department of Cardiology, European Hospital Georges Pompidou and Paris Cardiovascular Research Centre (INSERM U970), Paris, France; 5 Department of Cardiology, University Medical Centre Mainz, Mainz, Germany; 6 Department of Cardiology (CVK) of German Heart Centre Charité; German Centre for Cardiovascular Research (DZHK) partner site Berlin, Charité Universitätsmedizin, Berlin, Germany; 7 Cardiovascular Imaging Section, Department of Cardiology, Heart Institute, University Hospital Germans Trias i Pujol, Badalona, Spain; 8 Medizinische Klinik und Poliklinik I, LMU-Klinikum, LMU München, Munich, Germany; 9 German Centre for Cardiovascular Research (DZHK), partner site Munich Heart Alliance, Munich, Germany; and 10Department of Cardiology, Angiology and Internal Intensive Care, University Hospital of Saarland, Saarland University, Homburg, Germany Received 28 May 2025; revised 16 July 2025; accepted 2 1 August 2025 ; online publish-ahead-of-print 30 October 2025 Secondary mitral regurgitation (SMR) is highly prevalent in patients with heart failure (HF), associated with poor prognosis, and its treatment is typically preceded by implementing pharmacotherapy for HF as well as cardiac resynchronization therapy. Given the increase inexperience and important technological iterations, transcatheter mitral valve repair has witnessed increasing safety and efficacy. Recently, two randomized controlled trials extended the level of evidence for this intervention in patients with SMR: RESHAPE-HF2 randomized patients with less severe SMR to either medical therapy alone versus adjunct transcatheter repair, whereas the MATTERHORN trial compared surgical therapy with transcatheter mitral valve repair in patients with SMR and increased risk for surgery. These two trials have a potential impact on the indications of transcatheter repair. Here we discuss updated indications for transcatheter mitral valve therapy across the different subtypes of SMR, revisit the current body of evidence for transcatheter mitral valve repair and classify this technique into the current treatment hierarchy of SMR in patients with HF. .......................................................................................................... *Corresponding author. Department of Internal Medicine III, Faculty of Medicine and University Hospital Cologne, University of Cologne, and Center for Cardiovascular Medicine (CCM), partner site Cologne, Kerpener Str. 62, D-50937 Cologne, Germany. Email: [stephan.baldus@uk-koeln.de](stephan.baldus@uk-koeln.de) © 2025 The Author(s). European Journal of Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. Graphical Abstract The patient with SMR: From diagnostic assessment to treatment. ..............

FAQs

What is the clinical context for transcatheter mitral valve therapy in heart failure?

Secondary mitral regurgitation is highly prevalent in patients with heart failure and is associated with poor prognosis. Treatment is typically preceded by implementing pharmacotherapy and, when indicated, cardiac resynchronization therapy.

Which randomized trials are highlighted as extending evidence for transcatheter repair in SMR?

RESHAPE-HF2 randomized patients with less severe SMR to medical therapy alone versus adjunct transcatheter repair. MATTERHORN compared surgical therapy with transcatheter mitral valve repair in patients with SMR and assessed higher surgical risk.

How does the consensus frame the role of transcatheter mitral valve repair within current SMR management?

The statement revisits updated indications for transcatheter mitral valve therapy across SMR subtypes, re-evaluates the current evidence for transcatheter repair, and classifies the technique within the current treatment hierarchy for SMR in heart failure.

Sep 29, 2026

Uploaded by kopisore