Key result
DragonFly TEER reduces mixed mitral regurgitation to grade 1+ using a stepless self-locking strategy.
Why the study?
In patients requiring multiple clips for severe MR, a small mitral valve area limits TEER by increasing the risk of elevated transvalvular gradients and iatrogenic stenosis.
Case Report (n=1)
The 'Stepless Self-locking' strategy of the DragonFly TEER system allowed precise balancing of mitral regurgitation reduction and transmitral gradient preservation in a patient with complex mixed MR and a small mitral valve area.
Offers potential TEER option for high-risk mixed MR with small MVA; leaves open need for prospective validation of the strategy.
Background Transcatheter edge-to-edge repair (TEER) has emerged as an alternative treatment for severe mitral regurgitation (MR). However, complex anatomical features of mitral valve pose significant technical and procedural challenges for TEER. In patients whose effective regurgitation reduction requires multiple clips, a small valve area (MVA) limits TEER by increasing the risk of post-procedural elevated transvalvular gradients and iatrogenic stenosis. Case Summary A 90-year-old man presented with progressive tightness of breath that remained refractory to drug-based medical therapy. Echocardiography revealed severe mixed mitral regurgitation characterized by C1 segment prolapse and atrial functional mitral regurgitation with a small MVA of 4.09 cm2. Given his advanced age and prohibitive surgical risk [Society of Thoracic Surgeons (STS) score for repair: 10.49%], the multidisciplinary Heart Team elected to perform TEER using the DragonFlyTM system. The procedure was successfully performed under transoesophageal echocardiographic (TEE) guidance with the sequential implantation of two clips. The second clip utilized a “Stepless Self-locking” strategy to carefully balance the reduction of regurgitation against the transmitral pressure gradient elevation. Regurgitation was reduced from grade 4+ to 1+ with a final mean gradient of 4 mmHg and no evidence of significant mitral stenosis. The patient experienced a marked improvement in functional status during the follow-up period. Discussion This case highlights the importance of individualized anatomical assessment and tailored device selection in managing patients with MR and complex, challenging structure. Precise clip sizing and stepwise deployment strategies can successfully balance MR reduction while preserving MVA. Such tailored approaches are essential to prevent iatrogenic complications and optimize clinical outcomes in high-risk populations.
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Lin et al. (2026) conducted a case report in Severe mixed mitral regurgitation (n=1). Transcatheter edge-to-edge repair with DragonFly system and Stepless Self-locking strategy was evaluated on Mitral regurgitation grade and mean transvalvular gradient. Transcatheter edge-to-edge repair using the DragonFly system with a Stepless Self-locking strategy successfully reduced mixed mitral regurgitation from grade 4+ to 1+ with a final mean gradient of 4 mmHg.
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