Mitral Transcatheter Edge-to-Edge Repair for Anterior Leaflet Flail Induced by Transapical Transcatheter Aortic Valve Replacement

Transapical transcatheter aortic valve replacement (TA-TAVR) is a viable option for inoperable patients who are not eligible for a transfemoral route. Rarely, delayed complications such as primary mitral regurgitation (MR) may emerge owing to procedural factors. An 85-year-old patient deemed at high surgical risk underwent TA-TAVR successfully for severe symptomatic aortic stenosis. Two months after the procedure, he returned with progressive dyspnea secondary to severe MR caused by anterior mitral leaflet flail. Mitral transcatheter edge-to-edge repair (M-TEER) was performed with a significant reduction in MR severity and notable symptomatic improvement. This case describes an unusual late-onset complication of TA-TAVR. Early recognition and reintervention were key, as M-TEER offered a safe and effective strategy for treating this atypical complication. Severe primary MR can be a complication of TA-TAVR that may not be detectable in the immediate postoperative period, and M-TEER can be a valid option for its treatment.