Key result
Redo M-TEER with PASCAL successfully reduces recurrent severe DMR to mild with sustained stability.
Why the study?
Recurrent mitral regurgitation after initial mitral transcatheter edge-to-edge repair remains a therapeutic challenge and is associated with poor outcomes.
Case Report (n=1)
No
Redo transcatheter edge-to-edge repair using the PASCAL system is a feasible, safe, and durable option for severe recurrent degenerative mitral regurgitation even in complex calcified anatomy.
May support redo PASCAL repair in select recurrent degenerative MR; hypothesis-generating and requires prospective confirmation.
Background: Degenerative mitral regurgitation (DMR) is associated with substantial morbidity and mortality if left untreated. While surgical repair remains the gold standard, mitral transcatheter edge-to-edge repair (M-TEER) is an established alternative for patients at high surgical risk. However, recurrent MR after initial M-TEER remains a therapeutic challenge and is associated with poor outcomes. Case summary: device implantation for secondary MR at an external hospital in September 2019. Transoesophageal echocardiography revealed degenerative mitral valve disease characterized by a complex combination of posterior leaflet prolapse and anterior leaflet flail, resulting in a severe eccentric regurgitant jet.The patient underwent successful M-TEER with the MitraClip® system in December 2021. In June 2023, the patient was re-hospitalized for recurrent heart failure symptoms. Imaging revealed severe recurrent MR originating lateral to the implanted device. A redo M-TEER was performed using the PASCAL® system, requiring careful navigation through a narrow residual lateral orifice. The procedure resulted in a durable reduction to mild MR with sustained clinical stability at 18-month follow-up. Discussion: This case illustrates the anatomical challenges of DMR and demonstrates the feasibility and durability of redo M-TEER in high surgical risk patients with recurrent MR. It emphasizes the importance of individualized anatomical assessment and tailored device selection in complex valve anatomies.
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Pauschinger et al. (2025) conducted a case report in Recurrent degenerative mitral regurgitation (n=1). Redo mitral transcatheter edge-to-edge repair (M-TEER) using PASCAL system was evaluated on Reduction in mitral regurgitation severity. Redo transcatheter mitral edge-to-edge repair using the PASCAL system successfully reduced recurrent severe degenerative mitral regurgitation to mild regurgitation with sustained clinical stability at 18-month follow-up.
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