Mission M-Possible: Mitral Transcatheter Edge-to-Edge Repair in Mitral Annular Calcification Using the Crab-Walk Technique.

Background: Mitral annular calcification (MAC) complicates transcatheter interventions for degenerative mitral regurgitation (DMR), particularly with small mitral valve orifice areas (MVOAs). Case Summary: An 83-year-old woman with severe DMR, severe MAC, and MVOA of 3.8 cm2 presented post-heart failure hospitalization with declining function. High surgical risk and unfavorable transcatheter mitral valve replacement anatomy (neo-LVOT 0.30 cm2) limited options to transcatheter edge-to-edge repair (TEER). Using the Edwards PASCAL precision system and the "Crab-Walk" technique (independent leaflet clasp manipulation for MAC-related challenges), TEER reduced mitral regurgitation to mild (1+), with a 2 mmHg gradient at 3 months. The patient was weaned off oxygen and remains asymptomatic at 1 year. Discussion: This first reported mitral TEER case in DMR with significant MAC and small MVOA highlights the "Crab-Walk" technique's innovation. Take-Home Messages: TEER with novel techniques is viable for DMR with MAC when transcatheter mitral valve replacement is prohibitive.