Title : Mitral TEER as a bridge-to-recovery: A life-changing alternative to transplantation in advanced heart failure
Abstract:
Advanced Heart Failure (AHF) remains a major clinical challenge due to its high morbidity and mortality. While Guideline-Directed Medical Therapy (GDMT) has improved patient outcomes, those with secondary Ischaemic Mitral Regurgitation (IMR) continue to have a poor prognosis. Timely and strategic interventions in these patients are critical to delay or avoid the need for advanced therapies such as cardiac transplantation.
We present a compelling case of a male patient in his mid-30s with heart failure due to ischaemic heart disease, complicated by severe mitral regurgitation. The patient was admitted with New York Heart Association (NYHA) class IV heart failure and was being considered for cardiac transplantation. After initial haemodynamic optimization using intravenous diuretics and inotropes, Right Heart Catheterization (RHC) was performed, which showed a marked improvement in cardiac and pulmonary pressures during a milrinone challenge.
Given the favourable RHC profile and fulfilment of COAPT trial criteria, the patient was considered for mitral Transcatheter Edge-To-Edge Repair (m-TEER) as a Bridge-To-Decision (BTD) therapy. Following the procedure, the patient experienced significant improvements in NYHA class, cardiac pressures, peak oxygen consumption, and tolerance to prognostic medications. Remarkably, these improvements enabled the patient to be removed from the cardiac transplant list.
This case aligns with findings from the international Mitra Bridge registry, which supports m- TEER as a safe and effective strategy in selected AHF patients with severe IMR, showing benefits in survival, hospitalization rates, and reduction in the need for advanced heart failure therapies. Our case reinforces the importance of multidisciplinary team evaluation and early procedural intervention to optimize outcomes in high-risk heart failure patients.
