Minimally invasive mitral valve replacement for posterior leaflet tear following transcatheter edge-to-edge repair using the MitraClip system: a case report

We report a case of an 80-year-old woman with severe mitral regurgitation, low ejection fraction, frailty, and acute decompensated heart failure. Due to her high surgical risk, transcatheter edge-to-edge repair using the MitraClip system (Abbott, Abbott Park, IL, USA) was attempted by the cardiology team. However, the procedure resulted in a posterior mitral leaflet tear with worsened severe mitral regurgitation. She was subsequently referred to our department, and owing to her clinical deterioration, urgent minimally invasive cardiac surgery mitral valve replacement was performed using a 29-mm bioprosthetic mitral valve (Epic; Abbott, Abbott Park, IL, USA). The patient had an uneventful recovery and was discharged on postoperative Day 13. Mitral valve surgery following failed MitraClip is considered high-risk, with elevated perioperative mortality. However, in frail patients with leaflet injury after MitraClip failure, minimally invasive cardiac surgery mitral valve replacement may represent a more appropriate and less invasive therapeutic option.