Snare-Assisted Retrieval of a Mechanically Locked-Open TEER Device: A Novel Bailout Technique

Transcatheter edge-to-edge repair (TEER) is an established intervention for patients having severe mitral regurgitation (MR) with prohibitive surgical risk. Complications during deployment related to device malfunction are uncommon but necessitate prompt decision-making and management. A 54-year-old gentleman with dilated cardiomyopathy, severe left ventricular dysfunction, and severe MR underwent TEER using the MyClip system (Meril Life Sciences Pvt. Ltd., Vapi, Gujarat, India). Initial deployment across the A2-P2 scallops of mitral leaflets achieved partial MR reduction. Significant residual MR required a second clip for optimal leaflet coaptation. While deploying the second clip, it failed to close because of a mechanical locking failure. So, we everted the clip, pulled back to LA, and it stayed in open position and failed to close. We report a novel bailout snare technique that enabled safe retrieval without the need for a second transseptal puncture. The ability to close the clip arms prior to withdrawal minimized the risk of tearing the atrial septum and facilitated the successful completion of the TEER procedure. Another clip was deployed successfully, resulting in significant MR reduction. This case demonstrates a rare complication during deployment, a malfunction of the device, and a novel strategy for safely bailing out a challenging intra-procedural complication.