Transcatheter Edge-to-Edge Mitral Valve Repair for Severe Regurgitation in Cardiogenic Shock: A Comprehensive Review

Cardiogenic shock is a critical pathological state marked by end-organ hypoperfusion due to severe cardiac dysfunction and is associated with high mortality. A substantial portion of patients with cardiogenic shock have concomitant severe mitral regurgitation (MR), which exacerbates hemodynamic instability by reducing forward cardiac output and contributes to pulmonary edema and respiratory failure through regurgitant backflow. In this high-risk setting, mitral transcatheter edge-to-edge repair (M-TEER) offers a minimally invasive treatment that can lead to hemodynamic and symptomatic improvement and potential mortality benefit. Initially indicated for patients with severe MR at prohibitive surgical risk, M-TEER is now guideline-supported for both primary and secondary MR in select populations. Emerging data suggest that M-TEER can reduce heart failure hospitalizations and improve patient quality of life. As clinical indications for M-TEER continue to expand, there is growing interest in the role of M-TEER as a stabilizing intervention in patients with cardiogenic shock and severe MR. This review aims to synthesize the current evidence surrounding the use of M-TEER in cardiogenic shock with a focus on patient selection, procedural and clinical considerations, and short- and long-term outcomes.