Key result
A third TEER procedure leads to anterior leaflet tear and death in heart failure.
Why the study?
Early postoperative mitral leaflet injury risk following multiple transcatheter edge-to-edge mitral valve repair procedures is not well characterized.
Case Report (n=1)
Performing multiple TEER procedures carries a risk of early postoperative leaflet injury, underscoring the need for careful patient selection and procedural planning.
Third TEER may risk leaflet tear and late death in HF; single case leaves open procedural safety limits.
We report a case of early postoperative anterior mitral leaflet tear following a third transcatheter edge-to-edge mitral valve repair (TEER) procedure in a patient with dilated cardiomyopathy and heart failure with reduced ejection fraction. The patient, who had previously undergone two TEER procedures, developed recurrent mitral regurgitation (MR) and subsequently underwent a third TEER. However, after the third TEER, the MR worsened on postoperative day 3. Due to haemodynamic instability, repeat transoesophageal echocardiography could not be performed. The patient died 7 months later. Autopsy revealed a large anterior leaflet tear near the third clip site, with differential endothelialisation between the third and earlier clips. This case highlights the risk of early postoperative leaflet injury following multiple TEER procedures and underscores the importance of careful patient selection and procedural planning in complex heart failure cases.
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Morinaga et al. (2025) conducted a case report in Dilated cardiomyopathy and heart failure with reduced ejection fraction (n=1). Third transcatheter edge-to-edge mitral valve repair (TEER) was evaluated on Anterior mitral leaflet tear and clinical outcome. A third transcatheter edge-to-edge mitral valve repair in 1 patient with heart failure resulted in an early postoperative anterior leaflet tear and death at 7 months.
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