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Published on: August 16, 2021
Protected Mitral TEER With Temporary Ventricular Circulatory Support in Severe Left Ventricular Dysfunction for Heart
Lukas Weber1, Julien Ternacle2, Johann Cattan3
1Unité Médico-Chirurgicale des Valvulopathies Hôpital Cardiologique Haut-Lévêque, CHU de Bordeaux, Pessac, France; Department of Cardiology, HOCH Health Ostschweiz, St Gallen, Switzerland.
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.
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