Case series of transcatherter edge-to-edge repair using MitraClip^™system with Impella^®mechanical circulatory support

Background: Secondary mitral regurgitation (SMR) is a major comorbidity in patients with heart failure with reduced ejection fraction (HFrEF). Transcatheter edge-to-edge repair (TEER) using the MitraClip™ system is a promising tool for selected patients with SMR and HFrEF. Durable success using this system in patients who have advanced heart failure and unsuitable anatomy remains a clinical challenge. Case summary: Three patients aged 67-72 years with HFrEF on inotropic support successfully underwent Impella®-assisted TEER at our centre. Following the procedure, two patients were able to be weaned off inotropic support and were discharged, while one patient expired during the index hospitalization. Discussion: Impella®-assisted TEER may be a feasible strategy for patients with SMR and HFrEF with unstable haemodynamics particularly when cardiac replacement therapy is not applicable.