Successful percutaneous retrieval of a detached MitraClip® in the left atrium via maintained gripper line: a case report

Abstract

Background: Mitral valve transcatheter edge-to-edge repair (M-TEER) with MitraClip® has become an established treatment for high-risk patients with mitral regurgitation (MR). While device-related complications are known, they typically occur during leaflet grasping or after deployment, with most issues arising from device-tissue interaction. Case summary: A 67-year-old woman with dilated cardiomyopathy underwent M-TEER for severe functional MR. Although resistance was noted during initial device preparation and loading, limited functional testing appeared normal and the procedure was continued. During clip manipulation in the left atrium, mechanical resistance in the arm positioner led to unexpected detachment of the MitraClip, connected only by the gripper line. Through careful traction under echocardiographic and fluoroscopic guidance, we successfully retrieved the clip percutaneously. The procedure was completed with new MitraClip systems, achieving mild residual MR. The patient's symptoms improved from New York Heart Association Classes II and III to I, with sustained improvement during 4.5 years of follow-up. Discussion: This case reveals a novel mechanism of MitraClip detachment through mechanical failure during preparation, where introducer damage led to harness deformation and subsequent clip detachment. Among available retrieval options, we demonstrated the feasibility of direct traction retrieval under specific conditions, offering a less invasive solution when gripper line connection is maintained. This case emphasizes the importance of meticulous device inspection and preparation, while providing insights into both failure mechanisms and retrieval strategies in M-TEER complications.