21 May 2026
Combined mitral repair and LAA closure with two separate septal punctures - LIVE case
With the collaboration of the PCR Mitral Focus Group
Summary
A 79‑year‑old man with hypertension, a history of basal cell carcinoma and psoriasis, presented with symptomatic severe primary MR (flail P2 due to ruptured chordae) and bleeding complications (recurrent skin bleeding) while on DOAC therapy for permanent atrial fibrillation.
Two G5 MitraClip devices were implanted. Subsequently, through a separate septal puncture using a VersaCross wire, LAA closure was performed with a Watchman FLX device during the same procedure under general anesthesia and transesophageal echocardiography (TEE) guidance.
LIVE Educational Case from Rigshospitalet Heart Centre - Copenhagen, Denmark
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Key moments
- 2:47 - 10:10 - Imaging analysis
- 20:53 - 25:05 - first post septal puncture
- 25:29 - 37:37 - G5 mitral clip implantation
- 38:00 - 43:46 - second septal puncture
- 44:49 - 59:45 - Watchman trusteer deployment
- 1:11:33 - 1:18:58 - procedural analysis
Keywords: Primary mitral regurgitation, LAA closure, septal puncture for mitral repair, septal puncture for LAA closure, G5 mitraclip, Watchman trusteer, Versacross wire
Learning Objectives
- To identify patients who are optimal candidates for combined M-TEER and LAAC procedures
- To learn the procedural challenges of performing both interventions in a single session
- To gain practical insights through a step-by-step guide to executing each phase of the combined approach effectively
