Double-Anchoring Transcatheter Mitral Valve Replacement: A Case Report of Septal Capture of Embolized Transcatheter Mitral Valves

Transcatheter mitral valve replacement (TMVR) after failed surgical repair with an incomplete annuloplasty ring remains technically challenging because the absence of anterior support compromises anchoring. We report a high-risk 63-year-old woman with severe recurrent mitral regurgitation after minimally invasive repair who underwent a staged, image-guided transcatheter strategy. A PASCAL Ace device (Edwards Lifesciences) was implanted at the medial commissure to augment the landing zone, followed by balloon atrial septostomy and antegrade LAMPOON (Laceration of the Anterior Mitral leaflet to Prevent Outflow Obstruction). Initial deployment of a 29-mm SAPIEN 3 Ultra valve (Edwards Lifesciences) produced a severe skirt leak, and valve-in-valve implantation resulted in embolization of both prostheses into the left atrium with cardiogenic shock. After emergent venoarterial extracorporeal membrane oxygenation, a third overfilled SAPIEN 3 Ultra valve was secured in the mitral position. The embolized valves were then immobilized against the interatrial septum using a 38-mm Amplatzer Septal Occluder (Abbott). This case demonstrates double-anchoring TMVR and septal capture as a feasible percutaneous bailout in complex failed-repair mitral anatomy.