Key result
Transcatheter edge-to-edge repair was utilized in 6 high-risk patients with severe left ventricular dysfunction (LVEF 10% to 20%) and severe to torrential mitral regurgitation.
Why the study?
Patients with severe LV dysfunction and mitral regurgitation are underrepresented in pivotal transcatheter edge-to-edge repair trials and have limited treatment options when guideline-directed medical therapy fails.
Case Report (n=6)
A multidisciplinary heart team approach can successfully enable transcatheter edge-to-edge repair in highly selected, advanced heart failure patients with profound ventricular dysfunction and limited therapeutic alternatives.
May expand options for severe MR with end-stage LV dysfunction when other therapies fail; leaves open need for prospective trials to guide selection and outcomes.
BACKGROUND: Patients with severe left ventricular (LV) dysfunction and mitral regurgitation are underrepresented in pivotal transcatheter edge-to-edge repair trials and are often ineligible for transplantation or LV assist devices, leaving limited options when guideline-directed medical therapy fails. CASE SUMMARY: We describe 6 patients aged 38 to 82 years with LV ejection fraction 10% to 20% and severe (4+) to torrential (5+) mitral regurgitation, 4 patients presenting in or near cardiogenic shock requiring inotropic, vasopressor, or intra-aortic balloon pump support. All underwent transcatheter edge-to-edge repair as our multidisciplinary heart team strategy evolved. DISCUSSION: With increasing experience, the heart team incorporated individualized pharmacologic or temporary mechanical support, preprocedural hemodynamic optimization, and anatomy-driven device selection. One patient initially referred for palliative care was subsequently reassessed and treated. This series illustrates how iterative multidisciplinary learning may expand transcatheter edge-to-edge repair candidacy in carefully selected, high-risk patients with advanced heart failure and profound ventricular dysfunction and limited therapeutic alternatives.
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AlBadri et al. (2026) conducted a case report in Advanced heart failure with severe left ventricular dysfunction and mitral regurgitation (n=6). Transcatheter edge-to-edge repair was evaluated. Transcatheter edge-to-edge repair was utilized in 6 high-risk patients with severe left ventricular dysfunction (LVEF 10% to 20%) and severe to torrential mitral regurgitation.
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