Late-Onset Embolization of a Mitral Transcatheter Edge-to-Edge Repair Device

Transcatheter edge-edge repair (TEER) with the MitraClip device is a well-established treatment for severe symptomatic mitral regurgitation (MR) in high-risk surgical patients. We report a rare late-onset MitraClip embolization after the index procedure and its successful percutaneous retrieval.

An 82-year-old man presented with exertional dyspnea 30 days after TEER with MitraClip. Transthoracic echocardiography revealed MitraClip dislodgment behind the right coronary cusp. After heart team discussion, percutaneous removal was attempted. Angiographic and transesophageal echocardiography (TEE) guidance was used. An initial attempt with Aneri forceps was unsuccessful, causing migration to the descending aorta. Subsequent retrieval with the EN Snare system retrieved the clip successfully into a large-bore 24-F arterial sheath, which was then removed; hemostasis was achieved with a Manta and 2 Perclose devices. Final TEE confirmed intact aortic valve without complications.

TEER of MR with the MitraClip has an embolization rate of about 0.3%, although most cases occur in the immediate perioperative period. We report a rare case of embolization at 30 days follow-up after the procedure, with successful percutaneous retrieval of the embolized clip.

Successful outcomes after percutaneous MitraClip retrieval are achievable through angiographic and TEE guidance and careful selection of retrieval equipment.