Redo transcatheter mitral edge-to-edge repair using the PASCAL system successfully reduced severe recurrent mitral regurgitation to mild MR with sustained clinical stability at 18 months.
Case Report (n=1)
Redo M-TEER using the PASCAL system is feasible and can provide durable reduction in recurrent mitral regurgitation in patients with complex lateral jet anatomy.
Background: Degenerative mitral regurgitation (DMR) is associated with substantial morbidity and mortality if left untreated. While surgical repair remains the gold standard, mitral transcatheter edge-to-edge repair (M-TEER) is an established alternative for patients at high surgical risk. However, recurrent MR after initial M-TEER remains a therapeutic challenge and is associated with poor outcomes. Case summary: device implantation for secondary MR at an external hospital in September 2019. Transoesophageal echocardiography revealed degenerative mitral valve disease characterized by a complex combination of posterior leaflet prolapse and anterior leaflet flail, resulting in a severe eccentric regurgitant jet.The patient underwent successful M-TEER with the MitraClip® system in December 2021. In June 2023, the patient was re-hospitalized for recurrent heart failure symptoms. Imaging revealed severe recurrent MR originating lateral to the implanted device. A redo M-TEER was performed using the PASCAL® system, requiring careful navigation through a narrow residual lateral orifice. The procedure resulted in a durable reduction to mild MR with sustained clinical stability at 18-month follow-up. Discussion: This case illustrates the anatomical challenges of DMR and demonstrates the feasibility and durability of redo M-TEER in high surgical risk patients with recurrent MR. It emphasizes the importance of individualized anatomical assessment and tailored device selection in complex valve anatomies.
Pauschinger et al. (Wed,) conducted a case report in Degenerative mitral regurgitation (n=1). Redo transcatheter mitral edge-to-edge repair (M-TEER) using the PASCAL system was evaluated on Mitral regurgitation severity. Redo transcatheter mitral edge-to-edge repair using the PASCAL system successfully reduced severe recurrent mitral regurgitation to mild MR with sustained clinical stability at 18 months.