Transcatheter edge-to-edge repair and left ventricular assist devices for secondary mitral regurgitation in advanced heart failure: a scoping review.

BACKGROUND

Secondary mitral regurgitation (SMR) worsens outcomes in advanced heart failure. Transcatheter edge-to-edge repair (TEER) and left ventricular assist device (LVAD) implantation represent advanced treatment options for patients with persistent symptoms despite guideline-directed medical therapy (GDMT).

METHODS

A scoping review using a PICO framework identified contemporary studies published up to 2025 involving adults with advanced heart failure (NYHA III-IV, INTERMACS 1-7) and ≥moderate SMR. Outcomes included mortality, heart failure hospitalizations, functional status, mitral regurgitation reduction, ventricular remodeling, complications, and quality of life.

RESULTS

Nine studies including over 2,000 patients were analyzed (mean age 60-72 years; LVEF 15-33%). TEER was associated with lower mortality and fewer heart failure hospitalizations compared with GDMT in selected patients. LVAD recipients generally had more advanced disease (predominantly INTERMACS 1-3) with higher early mortality but substantial functional improvement. TEER achieved MR ≤ 2 + in 84-99% of patients with low procedural complication rates (1-9%), whereas LVAD therapy demonstrated greater functional improvement but higher device-related complications.

CONCLUSION

TEER is associated with improved outcomes in selected patients with advanced heart failure and SMR, while LVAD therapy remains essential for patients with end-stage disease requiring durable circulatory support.