Mitral repair on the edge: a case report of redo transcatheter mitral edge-to-edge repair for recurrent regurgitation in Complex lateral jet anatomy.

BACKGROUND

Degenerative mitral regurgitation (DMR) is associated with substantial morbidity and mortality if left untreated. While surgical repair remains the gold standard, mitral transcatheter edge-to-edge repair (M-TEER) is an established alternative for patients at high surgical risk. However, recurrent MR after initial M-TEER remains a therapeutic challenge and is associated with poor outcomes.

CASE SUMMARY: A 77-year-old patient presented with recurrent heart failure symptoms due to MR after prior CARILLON® device implantation for secondary MR at an external hospital in September 2019. Transoesophageal echocardiography revealed degenerative mitral valve disease characterized by a complex combination of posterior leaflet prolapse and anterior leaflet flail, resulting in a severe eccentric regurgitant jet.The patient underwent successful M-TEER with the MitraClip® system in December 2021. In June 2023, the patient was re-hospitalized for recurrent heart failure symptoms. Imaging revealed severe recurrent MR originating lateral to the implanted device. A redo M-TEER was performed using the PASCAL® system, requiring careful navigation through a narrow residual lateral orifice. The procedure resulted in a durable reduction to mild MR with sustained clinical stability at 18-month follow-up.

DISCUSSION: This case illustrates the anatomical challenges of DMR and demonstrates the feasibility and durability of redo M-TEER in high surgical risk patients with recurrent MR. It emphasizes the importance of individualized anatomical assessment and tailored device selection in complex valve anatomies.