Key result
Heart Team evaluation prevents futile TEER and optimizes LVAD or transplant timing in advanced HF.
Why the study?
Clinical distinction between candidates for LVAD and TEER can be unclear in practice, and LVADs remain underused partly due to late referral in advanced heart failure with significant mitral regurgitation.
A multidisciplinary Heart Team approach is essential to optimize patient selection and timing for TEER versus LVAD in advanced heart failure.
Supports multidisciplinary evaluation to time advanced therapies and avoid futile TEER; leaves open prospective validation of selection criteria.
The implantation of left ventricular assist devices (LVADs) has been increasing, with good long-term results, in parallel with a growing population with advanced heart failure (HF). However, in some European countries, LVADs are still underused, with one of the main issues being the patient's late referral. On the contrary, the use of transcatheter edge-to-edge mitral valve repair (TEER) has exponentially increased over the past decade, expanding its potential use even in patients on the heart transplantation waiting list. Even though the study populations of the main trials that investigated the prognostic impact of LVAD and TEER are different, in clinical practice a clear distinction might not be so clear. Therefore, patients with refractory HF symptoms and significant mitral regurgitation should be thoroughly evaluated through a multidisciplinary Heart Team meeting with both an advanced HF specialist and interventional cardiologist, to avoid futile procedures and to define the optimal timing for advanced HF therapies, when they are indicated. We analyzed the main available studies and registries on both TEERs and LVADs and we compared their populations and outcomes, to provide the current evidence on the use of LVAD and TEER in the HF population, especially in the light of the recently released 5-year follow-up results, giving some insights on the Italian situation, and finally to stress the importance of a solid HF network between hospitals, aiming for advanced HF patients' timely referral for LVAD or heart transplants.
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Valente et al. (2024) conducted a review in Advanced heart failure and secondary mitral regurgitation. Left ventricular assist device (LVAD) and transcatheter edge-to-edge mitral valve repair (TEER) was evaluated. A multidisciplinary Heart Team evaluation is essential for patients with advanced heart failure and significant secondary mitral regurgitation to determine the optimal timing for LVAD or heart transplantation and avoid futile transcatheter edge-to-edge mitral valve repair procedures.
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