{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,30]],"date-time":"2026-03-30T15:08:58Z","timestamp":1774883338709,"version":"3.50.1"},"reference-count":5,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2026,3,26]],"date-time":"2026-03-26T00:00:00Z","timestamp":1774483200000},"content-version":"vor","delay-in-days":25,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,3,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Mitral transcatheter edge-to-edge repair (TEER) is a safe and widespread treatment approach for severe mitral regurgitation (MR). However, rare but serious device-related complications, including single leaflet device attachment, perforation, and leaflet tear, may occur, often requiring surgical correction.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case summary<\/jats:title>\n                    <jats:p>An 82-year-old man with congestive heart failure and ischaemic cardiomyopathy underwent mitral TEER using MitraClip XTW clip for severe functional MR. Two days after the procedure, MR recurrence due to a leaflet tear was observed. Given the patient\u2019s advanced age and reduced left ventricular function, our cardiac team decided to perform a transcatheter bail-out procedure. First, the tear was converted to a hole shape by implanting a PASCAL Ace device (Edwards Lifesciences) lateral to the XTW, as this device has a lower risk of leaflet damage compared to the MitraClip device. Then, Amplatzer Vascular Plug II (AVP II) was deployed into the hole, with its mid-lobe positioned in contact with the devices and leaflets. After releasing the AVP II, the MR jet reduced to mild.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>An optimal bail-out strategy for leaflet tears has not yet been established. When it is difficult to sufficiently cover the leaflet tear using only an additional TEER device, the use of a plug with additional TEER devices can be considered a bail-out strategy.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ehjcr\/ytag218","type":"journal-article","created":{"date-parts":[[2026,3,20]],"date-time":"2026-03-20T12:44:26Z","timestamp":1774010666000},"source":"Crossref","is-referenced-by-count":0,"title":["Plug-based bail-out strategy for leaflet tear after mitral transcatheter edge-to-edge repair: a case report"],"prefix":"10.1093","volume":"10","author":[{"given":"Naoki","family":"Nishiura","sequence":"first","affiliation":[{"name":"Department of Cardiovascular Medicine, Kurashiki Central Hospital , 1-1-1 miwa, Kurashiki, Okayama 710-8602 ,","place":["Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4794-7843","authenticated-orcid":false,"given":"Shunsuke","family":"Kubo","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Kurashiki Central Hospital , 1-1-1 miwa, Kurashiki, Okayama 710-8602 ,","place":["Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kohei","family":"Osakada","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Kurashiki Central Hospital , 1-1-1 miwa, Kurashiki, Okayama 710-8602 ,","place":["Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0253-7966","authenticated-orcid":false,"given":"Takeshi","family":"Maruo","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Kurashiki Central Hospital , 1-1-1 miwa, Kurashiki, Okayama 710-8602 ,","place":["Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mitsuru","family":"Abe","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Kurashiki Central Hospital , 1-1-1 miwa, Kurashiki, Okayama 710-8602 ,","place":["Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2026,3,26]]},"reference":[{"key":"2026033010374289300_ytag218-B1","doi-asserted-by":"crossref","first-page":"104767","DOI":"10.1016\/j.compbiomed.2021.104767","article-title":"Comparative computational analysis of PASCAL and MitraClip implantation in a patient-specific functional mitral regurgitation model","volume":"136","author":"Errthum","year":"2021","journal-title":"Comput Biol Med"},{"key":"2026033010374289300_ytag218-B2","doi-asserted-by":"crossref","first-page":"ytad438","DOI":"10.1093\/ehjcr\/ytad438","article-title":"Bailout clipping of a leaflet perforation during mitral transcatheter edge-to-edge repair using a larger clip size: a case report","volume":"7","author":"Nishiura","year":"2023","journal-title":"Eur Heart J Case Rep"},{"key":"2026033010374289300_ytag218-B3","doi-asserted-by":"crossref","first-page":"529","DOI":"10.1016\/j.jcin.2024.11.031","article-title":"CLASP the hole: PASCAL ACE implantation for leaflet perforation caused by the MitraClip device","volume":"18","author":"Fujita","year":"2025","journal-title":"JACC Cardiovasc Interv"},{"key":"2026033010374289300_ytag218-B4","doi-asserted-by":"crossref","first-page":"1280","DOI":"10.1016\/j.jcin.2016.03.011","article-title":"Transcatheter procedure for residual mitral regurgitation after MitraClip implantation using amplatzer duct occluder II","volume":"9","author":"Kubo","year":"2016","journal-title":"JACC Cardiovasc Interv"},{"key":"2026033010374289300_ytag218-B5","doi-asserted-by":"crossref","first-page":"e41","DOI":"10.1016\/j.jcin.2021.12.009","article-title":"Plug and clip: percutaneous repair of a perforated mitral valve complicating severe functional mitral regurgitation","volume":"15","author":"Lai","year":"2022","journal-title":"JACC Cardiovasc Interv"}],"container-title":["European Heart Journal - 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