Transcatheter Edge-to-Edge Repair in Advanced Heart Failure and Ventricular Dysfunction: An Evolving Heart Team...

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.

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.

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.