Key result
TEER-based annular cinching enables successful TMVR in an oversized annuloplasty ring.
Why the study?
Annular reduction by cinching with transcatheter edge-to-edge repair has been described for valve-in-mitral annular calcification, but its application in annuloplasty rings too large for available transcatheter heart valves required demonstration.
Case Report (n=1)
The ARCTIC CIRCLE technique may represent a viable, minimally invasive option for enabling transcatheter mitral valve replacement in prohibitive-risk patients with annuloplasty rings that are traditionally too large for commercially available transcatheter heart valves.
OBJECTIVE: Annular reduction by cinching with transcatheter edge-to-edge repair in commissure has been described to enable valve-in-mitral annular calcification. We applied this technique to a patient with an annuloplasty ring too large to allow for treatment with available transcatheter heart valves. KEY STEPS: The key steps included the following: Gated computed tomography for measurement of annuloplasty ring, anterior mitral leaflet, and estimated neo-left ventricular outflow tract (LVOT). Transseptal left atrial access is obtained. Mitral transcatheter edge to edge repair (MTEER) is performed with preference for A3-P3 implant. Adjunctive antegrade base-to-tip laceration of the anterior mitral valve leaflet to prevent LVOT obstruction is performed if indicated. Transcatheter heart valve (THV) delivery and deployment. POTENTIAL PITFALLS: The potential pitfalls included the following: Medial deployment of the MTEER device is preferred due to the tendency of the THV to engage the lateral mitral anulus during advancement. Assessment of the neo-LVOT must consider the left ventricular septum and the anterior mitral leaflet. The degree of annular change after MTEER is unknown. TAKE-HOME MESSAGE: In the setting of a mitral annuloplasty ring larger than commercially available THVs, annular reduction by cinching with TEER in commissure in conventionally inappropriate ring for transcatheter valve may be a viable option for enabling transcatheter mitral valve replacement.
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Chidester et al. (2025) conducted a case report in Recurrent severe mitral regurgitation (n=1). Annular reduction by cinching with transcatheter edge-to-edge repair in commissure (ARCTIC CIRCLE) prior to transcatheter mitral valve replacement was evaluated on Valve stability and function at 30 days. Annular reduction by cinching with TEER successfully enabled transcatheter mitral valve replacement in an oversized annuloplasty ring, yielding normal valve function at 30 days.
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