Mitral Transcatheter Edge-to-Edge Repair in a Challenging Anatomy with Deeply Implanted Self-Expanding Valve and Severe Mitral Annular Calcification: A Case Report

Mitral transcatheter edge-to-edge repair (M-TEER) in the setting of prior transcatheter aortic valve replacement (TAVR) and severe mitral annular calcification (MAC) can pose procedural challenges. We describe the case of an 82-year-old woman with prior TAVR (29 mm EVOLUT FX+; Medtronic), P2 flail, and heavy circumferential MAC underwent M-TEER with the PASCAL Ace device (Edwards Lifesciences). This case illustrates that M-TEER can be performed safely and effectively in anatomies complicated by severe MAC and prior TAVR with careful preprocedural planning, intraprocedural imaging, and operator experience.