Mitral Transcatheter Edge-to-Edge Repair in Acute Ischemic Mitral Regurgitation: Current Evidence and Future Perspectives

Abstract

Acute ischemic mitral regurgitation is a rare but potentially catastrophic complication following acute myocardial infarction (AMI), characterized by severe clinical presentation and high mortality. Meanwhile, advancements in primary percutaneous coronary intervention (PCI) have reduced the incidence of acute mitral regurgitation (AMR). The surgical approach remains the standard treatment but is associated with high rates of complications and in-hospital mortality, particularly in patients with cardiogenic shock or mechanical complications, such as papillary muscle rupture. Mitral transcatheter edge-to-edge repair (M-TEER) has emerged as a minimally invasive treatment. Current evidence demonstrates the feasibility and safety of M-TEER in reducing mitral regurgitation, stabilizing hemodynamics, and improving in-hospital and short-term survival. The procedural success rate is high, with notable symptoms and functional status improvements. Mortality rates remain significant, reflecting the severity of AMR, but are lower compared to medical management alone. Challenges remain regarding the optimal timing of M-TEER, long-term device durability, and patient selection criteria. Ongoing iterations in device technology and procedural techniques are expected to enhance outcomes. This review highlights the role of M-TEER in AMR management, emphasizing the need for multidisciplinary decision-making and further research to refine M-TEER application and improve outcomes in this high-risk AMR population.

Keywords: Mitraclip; acute mitral regurgitation; mitral transcatheter edge-to-edge repair.

Fig. 1.

Mechanism of acute mitral regurgitation for primary and secondary phenotype.

Fig. 2.

Management of severe mitral regurgitation after acute myocardial infarction according to clinical patient stability and mitral regurgitation mechanism assessment. IABP, intra-aortic balloon pump; MCS, mechanical circulatory support; TEER, transcatheter edge-to-edge repair; SBP, systolic blood pressure.

Fig. 3.

Patient with severe mitral regurgitation after myocardial infarction treated with M-TEER. (A,B) Severe mitral regurgitation due to anterolateral papillary muscle rupture and subsequent P2 leaflet flail. (C) First Mitraclip XTW positioning, before grasping. (D) Result after releasing the first Mitraclip XTW. (E) Orientation of the second Mitraclip XTW. (F) Final result after releasing the second. M-TEER, mitral transcatheter edge-to-edge repair.