Related Experiment Video
Updated: Jun 16, 2026

Fully Endoscopic Mitral Valve Repair with Percutaneous Cannulation of Groin Vessels
Published on: May 26, 2023
Transcatheter Mitral Edge-to-Edge Repair With Intra-Aortic Balloon Pump Support in Severe Left Ventricular
Sary Wedinly1, Rasha Al-Bawardy2, Wail Kashkari1
1King Abdullah International Medical Research Center, Jeddah, Saudi Arabia; King Faisal Cardiac Center, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Jeddah, Saudi Arabia.
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.
More Related Videos
08:31A Simplified Stepwise Approach to Echo Guidance during Percutaneous Mitral Valve Repair
Published on: October 16, 2021
13:10Direct Re-implantation of Left Coronary Artery into the Aorta in Adults with Anomalous Origin of Left Coronary Artery from the Pulmonary Artery (ALCAPA)
Published on: April 24, 2017
Related Concept Videos
Mitral Stenosis III: Medical Management
Mitral Regurgitation III: Medical Management
Aortic Regurgitation III: Medical Management
Cardiomyopathy V: Interprofessional Care