Leaflet-to-Ring Edge-to-Edge Repair With Paravalvular Leak Closure for Dehisced Surgical Mitral Annuloplasty

BACKGROUND: Percutaneous mitral valve repair after surgical annuloplasty is not well described but represents an important therapeutic option for patients with prohibitive risk for redo surgery. CASE SUMMARY: An 85-year-old man with symptomatic severe mitral regurgitation and hemolysis following prior mitral annuloplasty with a SimpliciT incomplete flexible band presented with anterior leaflet prolapse, a markedly deficient posterior leaflet, and posterior ring dehiscence. He underwent a combined percutaneous strategy of mitral transcatheter edge-to-edge repair (M-TEER) with anterior leaflet-to-annuloplasty ring clipping and paravalvular leak (PVL) closure using a vascular plug, resulting in reduction of mitral regurgitation from severe to mild-to-moderate and resolution of hemolysis. DISCUSSION: Annuloplasty ring dehiscence is generally considered unfavorable for transcatheter mitral valve replacement with current-generation devices, leaving limited percutaneous treatment options for patients with recurrent mitral regurgitation after surgery. This case demonstrates the feasibility of combining M-TEER with PVL closure to address complex mixed intravalvular and paravalvular regurgitation in high-risk patients. TAKE-HOME MESSAGES: Combined M-TEER and PVL closure is an effective solution for recurrent mitral regurgitation in selected patients with deficient leaflet anatomy and annuloplasty ring dehiscence when guided by careful imaging and multidisciplinary heart team planning.