Surgical repair for a single leaflet device attachment due to a gripper failure from the MitraClip main frame: a case...

Percutaneous edge-to-edge repair with the MitraClip system is widely used in high-risk patients with mitral regurgitation. Single leaflet device attachment occurs due to leaflet tearing or inadequate leaflet capture. We report the first case of single leaflet device attachment caused by mechanical detachment of the MitraClip gripper from the main frame, resulting in severe mitral regurgitation and requiring surgical intervention.

A 72-year-old woman with a history of dilated cardiomyopathy underwent MitraClip implantation for severe mitral regurgitation. Two days postoperatively, echocardiography revealed single leaflet device attachment with severe mitral regurgitation. Preoperative echocardiography suggested detachment of the clip from the anterior mitral leaflet. Intraoperative findings revealed detachment of the device from the anterior mitral leaflet, with the gripper dislodged from the MitraClip main frame. A careful retrospective review of preoperative transthoracic echocardiography findings revealed a hyperechoic structure within the left ventricular wall without mobility. The gripper was not visualized during endoscopic exploration; therefore, removal was not attempted, and mitral valve replacement was performed. Postoperative course was uncomplicated, and follow-up transthoracic echocardiography demonstrated no gripper mobility within the left ventricle.

To our knowledge, gripper detachment has not previously been reported as a cause of single leaflet device attachment. While echocardiography may be limited in detecting device-related failures preoperatively, computed tomography may aid in identifying retained device fragments before the procedure. This case highlights the importance of understanding device structure and anticipating rare mechanical failures when planning reintervention following MitraClip therapy.