Transcatheter Edge-to-Edge Repair for Mitral Regurgitation in Complex Post-Surgical Anatomy

The objective of this study was to describe a transcatheter edge-to-edge repair procedure for severe mitral regurgitation (MR) in a patient with complex anatomy because of prior surgical ring implantation and posterior dehiscence.

The key steps are as follows: 1) preprocedural transesophageal echocardiography (TEE) identified wide posterior ring dehiscence with severe MR; 2) the detached surgical ring was located at the coaptation plane, complicating access; 3) the delivery system was navigated outside the ring to avoid interference; 4) a small clip was used to facilitate crossing, followed by sequential implantation of 2 NTW clips to reduce MR; and 5) final TEE confirmed mild residual MR and acceptable transmitral gradient.

The potential pitfalls included the following: 1) difficult access because of altered mitral geometry and ring displacement; 2) risk of device malposition or interaction with the surgical ring; and 3) precise imaging guidance and clip selection are essential to success.

Transcatheter edge-to-edge repair can be safely and effectively performed in anatomically complex postsurgical settings when standard approaches are not feasible.