ELASTACLIP and TMVR for Failed TEER With Leaflet Tear

Severe mitral regurgitation (MR) after unsuccessful mitral transcatheter edge-to-edge repair (M-TEER) is relatively uncommon. Elderly comorbid patients may have limited options for definitive MR treatment after failed TEER.

A 72-year-old woman with dilated cardiomyopathy presented with symptomatic severe functional MR and underwent M-TEER. During the procedure, the patient developed hemodynamic instability due to posterior leaflet tear with torrential MR which could not be addressed by the TEER. The patient had refractory heart failure despite medical therapy and was not an operative candidate. Following heart team discussion, she underwent ELASTACLIP followed by transcatheter mitral valve replacement using SAPIEN M3. Her condition promptly stabilized, and she was discharged home with stable NYHA II symptoms and trace MR at follow-up.

Failed M-TEER with significant residual MR carries a high risk of mortality with limited treatment options. Transcatheter mitral valve replacement with ELASTACLIP is a feasible and definitive solution in selected patients after failed M-TEER.

ELASTACLIP with transcatheter mitral valve replacement using SAPIEN M3 is a safe and effective option for failed M-TEER.