Key result
Bail-out combining additional TEER and vascular plug reduces recurrent MR to mild after leaflet tear.
Why the study?
Mitral TEER complications like leaflet tear often require surgical correction, but an optimal transcatheter bail-out strategy has not been established.
Does a plug-based bail-out strategy reduce mitral regurgitation in a patient with a leaflet tear after mitral TEER?
Does a plug-based bail-out strategy reduce mitral regurgitation in a patient with a leaflet tear after mitral TEER?
A plug-based strategy combining an additional TEER device and a vascular plug can be an effective transcatheter bail-out option for leaflet tears following mitral TEER in patients at high surgical risk.
May offer transcatheter bail-out for leaflet tears after TEER in high-risk patients; extends options but remains hypothesis-generating.
Background Mitral transcatheter edge-to-edge repair (TEER) is a safe and widespread treatment approach for severe mitral regurgitation (MR). However, rare but serious device-related complications, including single leaflet device attachment, perforation, and leaflet tear, may occur, often requiring surgical correction. Case summary An 82-year-old man with congestive heart failure and ischemic cardiomyopathy underwent mitral TEER using MitraClip XTW clip for severe functional MR. Two days after the procedure, MR recurrence due to a leaflet tear was observed. Given the patient’s advanced age and reduced left ventricular function, our cardiac team decided to perform a transcatheter bail-out procedure. First, the tear was converted to a hole shape by implanting a PASCAL Ace device (Edwards Lifesciences) lateral to the XTW, as this device has a lower risk of leaflet damage compared to the MitraClip device. Then, Amplatzer Vascular Plug II (AVP II) was deployed into the hole, with its mid-lobe positioned in contact with the devices and leaflets. After releasing the AVP II, the MR jet reduced to mild. Conclusion An optimal bail-out strategy for leaflet tears has not yet been established. When it is difficult to sufficiently cover the leaflet tear using only an additional TEER device, the use of a plug with additional TEER devices can be considered a bail-out strategy.
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Nishiura et al. (2026) studied this question. A plug-based bail-out strategy combining an additional TEER device and an Amplatzer Vascular Plug II successfully reduced recurrent mitral regurgitation to mild following a leaflet tear.
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