Key result
TEER with IABP achieves ~100% procedural success in severe functional MR with profound LV dysfunction.
Why the study?
Patients with severe functional MR and advanced LV dysfunction (LVEF ≤20%, severely dilated ventricles, or hemodynamic instability) were excluded from landmark trials and lack guideline periprocedural mechanical support strategies.
Does transcatheter edge-to-edge repair (TEER) with IABP support improve procedural success and symptoms in patients with profound LV dysfunction and severe functional MR?
Case Report (n=5)
No
Does transcatheter edge-to-edge repair (TEER) with IABP support improve procedural success and symptoms in patients with profound LV dysfunction and severe functional MR?
Prophylactic or rescue IABP support during TEER is feasible and may safely enable MR reduction in patients with profound LV dysfunction who fall outside current trial eligibility criteria.
May support TEER feasibility with IABP in profound LV dysfunction; leaves open need for prospective trials before practice change.
BACKGROUND: Severe functional mitral regurgitation (MR) with advanced left ventricular (LV) dysfunction carries poor outcomes despite guideline-directed medical therapy. Patients with LV ejection fraction ≤20%, severely dilated ventricles, or hemodynamic instability were excluded from landmark trials. CASE SUMMARY: Five patients (LV ejection fraction: 9%-29%) with severe functional MR, ineligible for transplantation or LV assist device, underwent transcatheter edge-to-edge repair (TEER) with intra-aortic balloon pump (IABP) support. Procedural success was achieved in all, including 1 patient after a second TEER for recurrent MR. WHY BEYOND THE GUIDELINES: These patients fall outside COAPT (Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients With Functional Mitral Regurgitation) and current valvular guidelines, which offer no periprocedural mechanical support strategy. DISCUSSION: IABP provided hemodynamic stability and may have mitigated afterload mismatch. All patients achieved NYHA functional class I-II status at discharge, sustained on follow-up. TAKE-HOME MESSAGE: Prophylactic IABP might enable safe TEER in patients with LV ejection fraction ≤20% and severe functional MR who fall outside landmark trial criteria; a heart team approach may extend TEER to advanced heart failure patients with no other options.
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Wedinly et al. (2026) conducted a case report in Severe functional mitral regurgitation with left ventricular dysfunction (n=5). Transcatheter edge-to-edge repair (TEER) with intra-aortic balloon pump (IABP) support was evaluated on Procedural success. TEER with intra-aortic balloon pump support achieved procedural success in 5 patients with severe functional mitral regurgitation and profound LV dysfunction, improving all to NYHA class I-II.
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