Key result
Single-session combined M-TEER and LAAO via a steerable introducer proves feasible in high-risk frail patient.
Why the study?
Combined M-TEER and LAAO may be considered in high-risk patients with severe MR and AF, but optimal transseptal puncture sites differ, potentially limiting the feasibility of a single-session approach.
Case Report (n=1)
No
The use of a steerable introducer can facilitate successful single-session combined M-TEER and LAAO by overcoming the anatomical constraints of a mitral-oriented transseptal puncture.
Answers are grounded in this paper and cite their sources.
Hypothesis-generating for combined single-session M-TEER and LAAO in frail patients; prospective trials needed before adoption.
Background Combined mitral transcatheter edge-to-edge repair (M-TEER) and left atrial appendage occlusion (LAAO) may be considered in selected high-risk patients with severe mitral regurgitation (MR) and atrial fibrillation (AF). However, the optimal transseptal puncture site differs between procedures, potentially limiting the feasibility of a single-session approach. Clinical summary An 80-year-old frail woman with severe atrial functional MR, permanent AF, chronic kidney disease, and recent severe anaemia was referred for treatment. Considering the patient’s high thromboembolic and bleeding risk and overall frailty, a combined percutaneous approach was selected. A supero-posterior transseptal puncture optimized for mitral repair enabled successful M-TEER with significant MR reduction. Subsequent LAAO was challenged by suboptimal alignment with the appendage. The use of a steerable introducer restored coaxiality, allowing stable device delivery and successful deployment of a 24-mm occluder with complete sealing and no peri-device leak. Discussion This case demonstrates the feasibility of a combined one-stop strategy in frail patients at high procedural risk. It highlights the importance of procedural planning and the role of steerable delivery systems in overcoming anatomical constraints imposed by a mitral-oriented transseptal puncture, thereby facilitating successful completion of both interventions in a single session.
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Bonanni et al. (2026) conducted a case report in Severe mitral regurgitation and atrial fibrillation (n=1). Combined single-session M-TEER and LAAO using a steerable introducer was evaluated on Procedural success (successful M-TEER and LAAO). A combined single-session strategy of mitral transcatheter edge-to-edge repair and left atrial appendage occlusion using a steerable introducer was successfully performed in a frail 80-year-old woman.
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