TEER is associated with lower mortality and fewer heart failure hospitalizations compared with GDMT in selected patients, while LVAD therapy provides greater functional improvement but higher device complications.
Does TEER or LVAD improve outcomes compared to GDMT in adults with advanced heart failure and ≥moderate secondary mitral regurgitation?
TEER improves outcomes with low complications in selected advanced heart failure patients with secondary mitral regurgitation, while LVAD provides substantial functional improvement for end-stage disease despite higher complications.
Abstract Background Secondary mitral regurgitation (SMR) worsens outcomes in advanced heart failure. Transcatheter edge-to-edge repair (TEER) and left ventricular assist device (LVAD) implantation represent advanced treatment options for patients with persistent symptoms despite guideline-directed medical therapy (GDMT). Methods A scoping review using a PICO framework identified contemporary studies published up to 2025 involving adults with advanced heart failure (NYHA III–IV, INTERMACS 1–7) and ≥moderate SMR. Outcomes included mortality, heart failure hospitalizations, functional status, mitral regurgitation reduction, ventricular remodeling, complications, and quality of life. Results Nine studies including over 2,000 patients were analyzed (mean age 60–72 years; LVEF 15–33%). TEER was associated with lower mortality and fewer heart failure hospitalizations compared with GDMT in selected patients. LVAD recipients generally had more advanced disease (predominantly INTERMACS 1–3) with higher early mortality but substantial functional improvement. TEER achieved MR ≤ 2 + in 84–99% of patients with low procedural complication rates (1–9%), whereas LVAD therapy demonstrated greater functional improvement but higher device-related complications. Conclusion TEER is associated with improved outcomes in selected patients with advanced heart failure and SMR, while LVAD therapy remains essential for patients with end-stage disease requiring durable circulatory support.
Shakeel et al. (Thu,) conducted a review in Advanced heart failure with reduced ejection fraction and secondary mitral regurgitation (n=2,000). Transcatheter edge-to-edge repair (TEER) and Left ventricular assist device (LVAD) vs. Guideline-directed medical therapy (GDMT) was evaluated on Mortality, heart failure hospitalizations, functional status, and mitral regurgitation reduction. TEER is associated with lower mortality and fewer heart failure hospitalizations compared with GDMT in selected patients, while LVAD therapy provides greater functional improvement but higher device complications.