Transcatheter Mitral Valve Repair With MitraClip® in a Heart Transplant Recipient - Pushing the Limits of Percutaneous Valve Therapy

Sep 30, 2026

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Case report on a 62-year-old female who developed severe symptomatic functional mitral regurgitation 18 years after heart transplantation. Because her surgical risk was extremely high, transcatheter edge-to-edge mitral valve repair with the MitraClip® device was selected. The procedure was technically challenging due to altered post-transplant anatomy, yet it was completed successfully with substantial MR reduction. Early follow-up detected a small left atrial thrombus, which resolved after six weeks of oral anticoagulation. The case supports feasibility and safety and highlights the need for tailored post-procedural surveillance.

LanguageEnglish

CategoryHealthcare

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Reading Time10 min

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Review began 11/21/2025 Review ended 12/03/2025 Published 12/09/2025 © Copyright 2025 Gagliardi et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CCBY 4.0. , which permits unrestricted use , distribution , and reproduction in any medium , provided the original author and source are credited. DOI: 10.7759/cureus.98795 Open Access Case Report Transcatheter Mitral Valve Repair With MitraClip® in a Heart Transplant Recipient: Pushing the Limits of Percutaneous Valve Therapy Pasquale Gagliardi 1, 2 , Marco Ferlini 1, Romina Frassica 1, Mauro Acquaro 1, Leonardo De Luca 1 1. Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, ITA 2. Department of Molecular Medicine, University of Pavia, Pavia, ITA Corresponding author: Mauro Acquaro, [mauro.acquaro.md@gmail.com](mauro.acquaro.md@gmail.com) Abstract We report the case of a 62-year-old female who developed severe symptomatic functional mitral regurgitation (MR) 18 years after heart transplantation. Given her extremely high surgical risk, transcatheter edge-to-edge mitral valve repair with the MitraClip® device was selected as the most appropriate therapeutic option. The procedure was technically challenging due to altered post-transplant anatomy, but it was completed successfully without immediate complications and resulted in a substantial reduction in regurgitation. During early follow-up, a small left atrial thrombus was identified and subsequently resolved after a six-week course of oral anticoagulation. This report illustrates the feasibility and safety of transcatheter mitral repair in carefully selected heart transplant recipients and underscores the importance of tailored post-procedural surveillance in this complex population. Categories: Cardiology, Cardiac/Thoracic/Vascular Surgery, Transplantation Keywords: case report, heart transplantation, left atrial thrombus, mitraclip, mitral regurgitation, percutaneous edge to edge repair Introduction Mitral regurgitation (MR) in heart transplant recipients may result from annular dilation, graft dysfunction, or leaflet tethering [1] . Surgical correction is associated with substantial perioperative risk due to prior sternotomies, adhesions, and comorbidities related to chronic immunosuppression [2] . Transcatheter mitral valve repair with the MitraClip® system has emerged as a valuable alternative for patients with symptomatic severe MR who are considered prohibitive surgical candidates; however, published experience in the transplant population remains limited [3,4] . We describe a technically demanding but successful MitraClip® procedure in a long-term heart transplant recipient and discuss thrombotic surveillance and management considerations in this unique clinical setting. Case Presentation A 62-year-old female with a history of orthotopic heart transplantation in 2006 for chemotherapy-induced cardiomyopathy and maintained on routine post-transplant follow-up presented with progressive exertional dyspnea (New York Heart Association class III) and worsening MR on serial transthoracic echocardiograms. Her medical history included stage IV chronic kidney disease with a stable estimated glomerular filtration rate of 35 ml/min/1 .73 m², prior endovascular aortic repair, and coronary stenting. Maintenance immunosuppression consisted of mycophenolate mofetil and everolimus. On March 15, 2024, transesophageal echocardiography (TEE) demonstrated preserved left ventricular ejection fraction (65%) and severe MR secondary to fibro-degenerative valve leaflet alterations, including posterior leaflet hypomobility and marked left atrial enlargement. Doppler indices suggested elevated left ventricular filling pressures without evidence of pulmonary hypertension. Following Heart Team evaluation, the patient was deemed high surgical risk, and transcatheter edge-to edge repair (TEER) with the MitraClip system was planned

FAQs

Why was MitraClip® considered for this patient instead of surgery?

The patient had extremely high surgical risk, making transcatheter edge-to-edge repair with the MitraClip® device the most appropriate option.

What made the MitraClip® procedure technically challenging?

Altered post-transplant anatomy distorted access, making septal crossing and leaflet grasping difficult and requiring multiple attempts.

What complication occurred during early follow-up and how was it managed?

A small left atrial thrombus was identified and resolved after a six-week course of oral anticoagulation.

Sep 30, 2026

Uploaded by Muffet