Transcatheter mitral valve repair improves outcomes in patients with heart failure and moderate-to-severe or severe secondary mitral regurgitation compared with medical therapy alone, according to data from the COAPT trial, presented at the 2018 TCT conference. A total of 614 patients were randomly assigned to receive a MitraClip device (Abbott) plus medical therapy or medical therapy alone. During 24 months of follow-up, the rate of the primary end point (hospitalizations for heart failure) was 35.8% per patient-year in the device group versus 67.9% per patient-year in the control group (HR 0.53, 95% CI 0.40–0.70, P < 0.001). The rate of the primary safety end point (freedom from device-related complication at 12 months) in the device group was 96.6%, which exceeded the prespecified objective performance goal of 88.0% (P < 0.001). All-cause mortality within 24 months was 29.1% and 46.1% in each group, respectively (HR 0.62, 95% CI 0.46–0.82, P < 0.001).