Transcatheter management of residual mitral regurgitation after transcatheter edge-to-edge repair: a systematic review

Background: Treatment of residual mitral regurgitation (MR) with different percutaneous devices after transcatheter edge-to-edge repair (TEER) has been reported as an alternative option to reclipping or surgery. This review aims at describing the different transcatheter strategies available and their results when managing residual MR after TEER. Methods: A literature search was undertaken across Pubmed, ScienceDirect, SciELO, DOAJ, and Cochrane library databases, to identify article reporting patients with post-TEER residual MR managed by a transcatheter approach that did not involve only the implantation of new clips. Results: From 439 deduplicated studies, 24 articles ultimately met the inclusion criteria. Fifteen described an occluder device implantation, 12 with an Amplatzer and 3 with a Cardioform. The most feared complications were hemolysis and device embolization. Three cases of transcatheter annuloplasty were reported in patients with residual functional MR. An electrosurgical detachment of the TEER device from the anterior mitral leaflet (ELASTA-Clip) before mitral valve replacement was reported in 6 articles. Conclusions: Transcatheter procedures addressing residual MR after TEER in carefully selected patients are feasible in experienced centers. Outcomes are promising despite some technical issues. Percutaneous strategies and related complications should be anticipated using multimodality imaging.