Protected Mitral TEER With Temporary Ventricular Circulatory Support in Severe Left Ventricular Dysfunction for Heart Failure Management

Q: What is the clinical evidence from this study?

Study design: Case Report. Population: Severe left ventricular dysfunction with secondary mitral regurgitation (n=1). Intervention: Mitral transcatheter edge-to-edge repair (M-TEER) with temporary Impella 5.0 support. Primary outcome: Clinical status and functional recovery at 3.5 years.

Q: What does this research mean for the field?

Elective mitral transcatheter edge-to-edge repair supported by temporary Impella 5.0 prevents afterload mismatch and enables sustained functional recovery without heart failure hospitalizations in severe left ventricular dysfunction. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Lukas Weber; Julien Ternacle; Johann Cattan; Melchior Jonveaux; Antoine Beurton; François Picard; François-Xavier Hérion; Thomas Modine; Lionel Leroux; Guillaume Bonnet

doi:10.1016/j.jaccas.2026.108783

June 1, 2026JACC Case ReportsOpen Access

Protected Mitral TEER With Temporary Ventricular Circulatory Support in Severe Left Ventricular Dysfunction for Heart Failure Management

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Key result

Temporary Impella 5.0 support enables safe M-TEER and sustained functional recovery in severe LV dysfunction.

n=1

Figures

Graphical abstract published by JACC Case Reports — Graphical abstract · Published by JACC Case Reports · CC BY

Why the study?

The safety of mitral transcatheter edge-to-edge repair in patients with severely impaired left ventricular function is limited by the risk of afterload mismatch.

Does elective M-TEER combined with temporary Impella 5.0 support improve outcomes and prevent afterload mismatch in severe left ventricular dysfunction with secondary mitral regurgitation?

Key Points

To evaluate the feasibility and safety of performing elective mitral transcatheter edge-to-edge repair under prolonged temporary ventricular support to prevent afterload mismatch in severe heart failure.
A 46-year-old man with ischemic cardiomyopathy, left ventricular ejection fraction of 26%, and severe secondary mitral regurgitation underwent elective M-TEER with two XTW clips.
Hemodynamic protection was provided using an Impella 5.0 device placed via subclavian access, maintained postprocedure and weaned stepwise over several days to facilitate gradual left ventricular adaptation.
At 1-month follow-up, NT-proBNP decreased from 3,879 pg/mL to 1,200 pg/mL, peak VO2 increased from 17 mL/kg/min to 22 mL/kg/min, and mean pulmonary arterial wedge pressure dropped from 33 mm Hg to 18 mm Hg.
The patient improved from NYHA class III to class I-II functional status and was successfully removed from the heart transplantation list.
At 3.5-year follow-up, the patient maintained clinical stability and NYHA class I-II status without any recurrent heart failure hospitalizations.

Study Design

Type

Case Report (n=1)

Multicenter

No

Structured PICO

Does elective M-TEER combined with temporary Impella 5.0 support improve outcomes and prevent afterload mismatch in severe left ventricular dysfunction with secondary mitral regurgitation?

P

Population

A 46-year-old man with ischemic cardiomyopathy, LVEF 26%, and severe secondary mitral regurgitation who underwent M-TEER under prolonged Impella support, followed for 3.5 years.

I

Intervention

Mitral transcatheter edge-to-edge repair (M-TEER) using 2 XTW Clips under mechanical circulatory support with Impella 5.0 via subclavian access, followed by prolonged stepwise weaning over 9 days.

O

Outcome

Functional recovery and clinical stability at 3.5-year follow-up

Combining M-TEER with prolonged temporary ventricular support via Impella safely mitigates afterload mismatch in patients with severe secondary mitral regurgitation and advanced heart failure.

Implication

Should not yet change practice in severe LV dysfunction with secondary MR; leaves open prospective validation of combined M-TEER and Impella.

Abstract

BACKGROUND: Mitral transcatheter edge-to-edge repair (M-TEER) is an established therapy for secondary mitral regurgitation in heart failure, but its safety in patients with severely impaired left ventricular function is limited by the risk of afterload mismatch. CASE SUMMARY: We report a 46-year-old man with ischemic cardiomyopathy, left ventricular ejection fraction of 26%, and severe secondary mitral regurgitation who underwent planned M-TEER under elective Impella 5.0 (Abiomed) support via subclavian access. Two XTW clips were successfully implanted. The Impella was maintained postprocedure and weaned stepwise over several days, enabling gradual left ventricular adaptation, hemodynamic stability, and early rehabilitation. DISCUSSION: Rapid reinitiation and uptitration of guideline-directed medical therapy led to sustained functional recovery and removal from the transplant list. At 3.5-year follow-up, the patient remains at NYHA functional class I-II status, with sustained clinical stability, improved exercise capacity, and no heart failure hospitalizations. CONCLUSIONS: This case illustrates a strategy combining elective M-TEER with temporary ventricular support to prevent afterload mismatch and safely reintroduce guideline-directed medical therapy in advanced heart failure.

Discussion

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Cite This Study

Weber et al. (2026) conducted a case report in Severe left ventricular dysfunction with secondary mitral regurgitation (n=1). Mitral transcatheter edge-to-edge repair (M-TEER) with temporary Impella 5.0 support was evaluated on Clinical status and functional recovery at 3.5 years. Elective M-TEER combined with temporary Impella 5.0 ventricular support successfully prevented afterload mismatch and enabled sustained functional recovery to NYHA class I-II at 3.5 years in a patient with severe left ventricular dysfunction.

synapsesocial.com/papers/6ab0b5c78ed769b125ec971a https://doi.org/10.1016/j.jaccas.2026.108783

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Protected Mitral TEER With Temporary Ventricular Circulatory Support in Severe Left Ventricular Dysfunction for Heart Failure Management

Figures

Key Points

Study Design

Structured PICO

Implication

Abstract

Discussion

Cite This Study

Protected Mitral TEER With Temporary Ventricular Circulatory Support in Severe Left Ventricular Dysfunction for Heart Failure Management

Figures

Key Points

Study Design

Structured PICO

Implication

Abstract

Discussion

Cite This Study

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