Key result
Second TEER device successfully resolves early single-leaflet device attachment and restores leaflet coaptation.
Why the study?
Single-leaflet device attachment (SLDA) is an uncommon but clinically significant complication of TEER associated with recurrent mitral regurgitation, requiring better understanding of management strategies.
Does bailout TEER with a second device reduce recurrent severe mitral regurgitation and improve symptoms in a patient with early single-leaflet device attachment?
Case Report (n=1)
Does bailout TEER with a second device reduce recurrent severe mitral regurgitation and improve symptoms in a patient with early single-leaflet device attachment?
Early single-leaflet device attachment following TEER in complex mitral anatomy can be effectively managed with an imaging-guided bailout procedure using a second device.
May support imaging-guided bailout with a second device for early SLDA; hypothesis-generating and leaves open need for prospective validation.
BACKGROUND: Single-leaflet device attachment (SLDA) is an uncommon but clinically significant complication of transcatheter edge-to-edge repair (TEER), associated with recurrent mitral regurgitation (MR). CASE SUMMARY: A 73-year-old man with heart failure and severe MR presented with progressive dyspnea despite optimal medical therapy. Imaging demonstrated complex degenerative mitral valve anatomy. TEER with a PASCAL P10 device achieved initial MR reduction and hemodynamic improvement. Early follow-up revealed SLDA with posterior leaflet detachment and recurrent severe MR. A bailout TEER with implantation of a second PASCAL Ace device restored leaflet coaptation and stabilized the initial device. DISCUSSION: This case highlights the importance of early imaging surveillance and suggests that device orientation may influence leaflet insertion in complex anatomy. Conventional clocking strategies, such as 11-5 orientation, may not ensure optimal leaflet engagement in all patients. TAKE-HOME MESSAGES: Device orientation should be individualized in complex mitral anatomy. Early SLDA can be effectively managed with imaging-guided bailout TEER.
No takes yet. Share an insight, caveat, or question.
Ververeli et al. (2026) conducted a case report in Severe mitral regurgitation and heart failure (n=1). Transcatheter edge-to-edge repair (TEER) was evaluated on Resolution of single-leaflet device attachment and recurrent severe mitral regurgitation. Early single-leaflet device attachment after transcatheter edge-to-edge repair was effectively managed with an imaging-guided bailout implantation of a second device, restoring leaflet coaptation.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: