ArticleJACC. Case reports2026
Transcatheter Mitral Edge-to-Edge Repair With Intra-Aortic Balloon Pump Support in Severe Left Ventricular Dysfunction.
Article in JACC. Case reports, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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10 authors.
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Abstract
backgroundSevere 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.
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