# Minimally invasive mitral valve replacement for posterior leaflet tear following transcatheter edge-to-edge repair using the MitraClip system: a case report

## TL;DR

An 80-year-old woman with heart failure underwent a minimally invasive mitral valve replacement after a failed MitraClip procedure, leading to a successful recovery.

## Contribution

This case highlights minimally invasive surgery as a viable option for frail patients with leaflet injury after MitraClip failure.

## Key findings

- The patient experienced severe mitral regurgitation after a posterior leaflet tear during the MitraClip procedure.
- Minimally invasive mitral valve replacement led to an uneventful recovery and discharge on postoperative Day 13.
- The case suggests that minimally invasive surgery may be preferable for high-risk patients with MitraClip complications.

## Abstract

We report a case of an 80-year-old woman with severe mitral regurgitation, low ejection fraction, frailty, and acute decompensated heart failure. Due to her high surgical risk, transcatheter edge-to-edge repair using the MitraClip system (Abbott, Abbott Park, IL, USA) was attempted by the cardiology team. However, the procedure resulted in a posterior mitral leaflet tear with worsened severe mitral regurgitation. She was subsequently referred to our department, and owing to her clinical deterioration, urgent minimally invasive cardiac surgery mitral valve replacement was performed using a 29-mm bioprosthetic mitral valve (Epic; Abbott, Abbott Park, IL, USA). The patient had an uneventful recovery and was discharged on postoperative Day 13. Mitral valve surgery following failed MitraClip is considered high-risk, with elevated perioperative mortality. However, in frail patients with leaflet injury after MitraClip failure, minimally invasive cardiac surgery mitral valve replacement may represent a more appropriate and less invasive therapeutic option.