Abstract
BACKGROUND: Double valve repair after failed transcatheter edge-to-edge repair and previous valve-sparing root replacement is technically challenging. CASE SUMMARY: A 61-year-old woman who had previously undergone a valve-sparing root replacement procedure subsequently developed moderate-to-severe mitral and aortic regurgitation. Given her surgical risk, transcatheter edge-to-edge repair was attempted; however, a leaflet tear and recurrent mitral regurgitation occurred. Imaging confirmed adequate leaflet anatomy, and surgical double valve repair was performed, including clip removal, leaflet plasty, ring annuloplasty for the mitral valve, and cusp plication for aortic valve plasty. DISCUSSION: This case highlights the feasibility of double valve repair after failed transcatheter edge-to-edge repair and previous root surgery. Preoperative imaging enabled the implementation of a repair-based strategy with preservation of native valves and provision for future transcatheter treatment options. TAKE-HOME MESSAGE: Imaging-guided assessment allowed for successful double valve repair after a failed MitraClip procedure and prior previous root surgery, preserving native valves and facilitating future treatment options.