Transjugular mitral transcatheter edge-to-edge repair with the PASCAL system®: a case report.

Background: Mitral transcatheter edge-to-edge repair (M-TEER) is an effective alternative therapeutic option for symptomatic mitral regurgitation (MR) in selected patients at high or prohibitive surgical risk. While this procedure is almost exclusively performed via the femoral veins, this approach is not feasible in some patients. The transjugular access may be used as an alternative route. Case summary: We report the case of a 72-year-old woman presenting with heart failure due to severe primary MR related to P2 flail leaflet, for which conventional surgery was deemed too high risk due to her altered general condition. Mitral transcatheter edge-to-edge repair with PASCAL device® was planned. However, the transfemoral approach failed due to severe kyphoscoliosis and inferior vena cava agenesis. A second procedure using transjugular approach was successful with the deployment of 2 PASCAL ACE implants®, resulting in a mild residual MR 1 + . Discussion: This is an unusual approach of transjugular M-TEER using the PASCAL device®. This innovative approach enables percutaneous treatment for high-risk patients with no transfemoral access as previously reported with the MITRACLIP system®. This procedure highlights the feasibility of the transjugular approach with the PASCAL device® for M-TEER.