Key result
Bail-out transcatheter mitral valve edge-to-edge repair with the MitraClip XTR system successfully reduced severe mitral regurgitation to mild grade after an acute single leaflet device attachment.
Why the study?
Acute single leaflet device attachment can occur during transcatheter mitral valve edge-to-edge repair, and bail-out repair often fails due to complex pathophysiology.
Case Report (n=1)
Bail-out TMVr with a different edge-to-edge repair device can successfully manage acute single leaflet device attachment, highlighting the importance of considering leaflet tissue characteristics during device selection.
Acute SLDA after PASCAL TMVr in thin leaflets may complicate bail-out; leaves open optimal rescue strategies in mixed-etiology MR.
BACKGROUND: An acute single leaflet device attachment (SLDA) may occur during transcatheter mitral valve edge-to-edge repair (TMVr), if an inadequate grasping of the target leaflet and/or a leaflet injury are concomitant. The bail-out TMVr often fails due to the complex pathophysiology. CASE SUMMARY: We report a case of an acute SLDA after TMVr with the PASCAL Repair System for severe mitral regurgitation (MR) with mixed aetiology, i.e., a thin-appeared posterior leaflet and pseudo-prolapse of the anterior mitral leaflet due to mitral annular dilatation. An acute SLDA occurred 2 min after the deployment, with device detachment of the posterior leaflet. A bail-out TMVr with the MitraClip XTR system led to an optimal MR reduction with the PASCAL stabilized. Despite an adequate leaflet insertion of the 1st device achieved, the posterior leaflet was tear due to its fragile tissue characteristics. At discharge, echocardiography confirmed an optimal MR reduction to mild grade with both devices stabilized. DISCUSSION: The pathology of the mitral valve leaflet is essential to achieve successful TMVr procedure using edge-to-edge repair device. Since the mechanical stress to the target leaflet appears to vary according to the edge-to-edge repair devices, the leaflet tissue characteristics should be respected during device selection.
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Kitamura et al. (2021) conducted a case report in Severe mitral regurgitation (n=1). Bail-out TMVr with the MitraClip XTR system was evaluated on Mitral regurgitation reduction. Bail-out transcatheter mitral valve edge-to-edge repair with the MitraClip XTR system successfully reduced severe mitral regurgitation to mild grade after an acute single leaflet device attachment.
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