Transcatheter edge-to-edge mitral repair with a nitinol device in cardiogenic shock on micro-axial flow-pump support: a case report.

Background: Severe functional mitral valve regurgitation due to acute myocardial infarction in the setting of profound cardiogenic shock presents a challenging treatment scenario. Persistent mitral regurgitation despite successful myocardial revascularization requires a careful and effective treatment approach. Case summary: A 54-year-old male was admitted to our cardiac arrest centre due to severe cardiogenic shock. The patient underwent percutaneous coronary intervention with stenting of the left main coronary artery, left anterior descending, and ostial left circumflex artery in the setting of a ST-elevation myocardial infarction. After successful revascularization, cardiogenic shock persisted and advanced temporary mechanical circulatory support (tempMCS) with extracorporeal membrane oxygenation and a micro-axial flow pump was required. Further diagnostic evaluation revealed severe functional mitral regurgitation despite sufficient left-ventricular unloading. We present a case in which tempMCS stabilized the patient and mitral regurgitation was successfully eliminated using a transcatheter edge-to-edge repair flexible nitinol device. Discussion: While mitral valve transcatheter edge-to-edge repair in cardiogenic shock on mechanical circulatory support is rare, it has shown feasibility and positive outcomes in limited reports. This is the first case using a nitinol edge-to-edge repair device in this context. Our report emphasizes the need for further discussion on device selection and comparative studies to optimize treatment in this high-risk group.