Transcatheter Mitral Valve Replacement Using Annular Reduction by Cinching With TEER in the Commissure (ARCTIC)

Area of Science:

• Cardiovascular Medicine
• Interventional Cardiology
• Structural Heart Disease

Background:

• Mitral annular calcification (MAC) with severe valve dysfunction presents a significant clinical challenge.
• High operative risks and limited transcatheter options complicate management for these patients.

Purpose of the Study:

• To describe the initial experience with a novel hybrid procedure for treating large mitral annuli.
• To evaluate the feasibility of combining commissural transcatheter edge-to-edge repair (TEER) with valve-in-MAC transcatheter mitral valve replacement (TMVR).

Main Methods:

• A two-stage hybrid approach was employed: commissural TEER using MitraClip followed by transseptal TMVR with a balloon-expandable aortic valve (SAPIEN 3).
• Patients selected had large mitral annuli and sufficient calcification, with high perceived risk of valve embolization.
• The procedure aimed to shorten intercommissural distance before valve replacement.

Main Results:

• The study included 13 patients with a median intercommissural distance of 39.1 mm and annular area of 930 mm².
• Commissural TEER was successful in all patients. Valve implantation was successful in 12 of 13 patients.
• Among successful implantations, paravalvular leak was mild (≤1+), with no leaks adjacent to the TEER device.

Conclusions:

• A hybrid TEER and SAPIEN valve replacement strategy is feasible for patients with large mitral annuli and MAC.
• This novel approach can facilitate transcatheter mitral valve replacement in challenging anatomies.