Mission M-Possible: Mitral Transcatheter Edge-to-Edge Repair in Mitral Annular Calcification Using the Crab-Walk...

Area of Science:

• Interventional Cardiology
• Structural Heart Disease
• Cardiac Surgery

Background:

• Mitral annular calcification (MAC) presents significant challenges for transcatheter interventions in degenerative mitral regurgitation (DMR).
• Small mitral valve orifice areas (MVOAs) further complicate treatment options for DMR with MAC.

Purpose of the Study:

• To report the first case of mitral transcatheter edge-to-edge repair (TEER) in a patient with severe DMR, severe MAC, and a small MVOA.
• To highlight the utility of the novel "Crab-Walk" technique in managing MAC-related challenges during TEER.

Main Methods:

• A patient with severe DMR, severe MAC, and MVOA of 3.8 cm² underwent TEER using the Edwards PASCAL system.
• The "Crab-Walk" technique, involving independent leaflet clasp manipulation, was employed to address MAC-related difficulties.

Main Results:

• Successful reduction of mitral regurgitation to mild (1+) post-TEER.
• A low transmitral gradient of 2 mmHg was observed at 3 months.
• The patient experienced significant clinical improvement, including weaning off oxygen and remaining asymptomatic at 1 year.

Conclusions:

• Transcatheter edge-to-edge repair (TEER) using innovative techniques like "Crab-Walk" is a viable option for DMR patients with MAC and prohibitive transcatheter mitral valve replacement anatomy.
• This case demonstrates the potential of TEER to improve outcomes in complex mitral valve disease.