Key result
M-TEER in LVAD candidates is linked to ~7% higher mortality risk per mm of baseline LVEDD.
Why the study?
The indication for M-TEER in patients with advanced heart failure and secondary mitral regurgitation who are favorable candidates for LVAD therapy remains unclear.
M-TEER can be safely performed in potentially favorable LVAD candidates, but long-term efficacy is limited, particularly in those with advanced LV remodeling.
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Supports safe M-TEER in potential LVAD candidates; leaves open long-term efficacy in advanced remodeling.
Background Transcatheter edge‐to‐edge repair of the mitral valve (M‐TEER) has shown promising outcomes in patients with advanced heart failure and significant mitral regurgitation. Similarly, outcomes after left ventricular assist device (LVAD) implantation have improved in advanced heart failure with/without mitral regurgitation. However, the indication of M‐TEER in favorable candidates for LVAD therapy remains unclear. Methods Potentially favorable LVAD candidates were defined as patients with advanced heart failure and secondary mitral regurgitation who underwent M‐TEER and were considered theoretically suitable for LVAD therapy based on data from the optimized catheter valvular intervention (OCEAN)‐Mitral registry. Among this cohort, Cox proportional hazards regression analysis was performed to identify factors associated with cardiovascular death following M‐TEER. Results A total of 3764 patients who underwent M‐TEER were included. Of them, 129 were identified as potentially favorable LVAD candidates (mean age: 67 years; 67% men). Despite advanced heart failure, procedural success was 96%. The 1‐year rate of cardiovascular death was 10.1%, increasing to 38.9% at 3 years. Baseline left ventricular end‐diastolic diameter was independently associated with cardiovascular death (hazard ratio: 1.07 per 1‐mm increase; 95% CI: 1.02–1.12; P =0.01). In patients with markedly enlarged left ventricles, symptom improvement was limited, and reverse remodeling was not achieved. Conclusions M‐TEER can be safely performed even in potentially favorable LVAD candidates. However, long‐term efficacy appears limited, particularly in those with advanced LV remodeling. Further studies are warranted to establish an optimal strategy, including the role of LVAD therapy versus M‐TEER, for this high‐risk population. Registration URL: https://center6.umin.ac.jp/cgi‐open‐bin/ctr/ctr_view.cgi?recptno=R000027188 .
Tanaka et al. (2026) studied this question. M-TEER in potential LVAD candidates achieved 96% procedural success but a 38.9% 3-year cardiovascular death rate, with baseline LV end-diastolic diameter increasing mortality risk (HR 1.07/mm).
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