{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T20:15:13Z","timestamp":1788466513072,"version":"build-2803163510"},"reference-count":5,"publisher":"Oxford University Press (OUP)","issue":"9","license":[{"start":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T00:00:00Z","timestamp":1788307200000},"content-version":"vor","delay-in-days":6,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,8,27]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Combined mitral transcatheter edge-to-edge repair (M-TEER) and left atrial appendage occlusion (LAAO) may be considered in selected high-risk patients with severe mitral regurgitation (MR) and atrial fibrillation (AF). However, the optimal transseptal puncture site differs between procedures, potentially limiting the feasibility of a single-session approach.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case summary<\/jats:title>\n                    <jats:p>An 80-year-old frail woman with severe atrial functional MR, permanent AF, chronic kidney disease, and recent severe anaemia was referred for treatment. Considering the patient\u2019s high thromboembolic and bleeding risk and overall frailty, a combined percutaneous approach was selected. A supero-posterior transseptal puncture optimized for mitral repair enabled successful M-TEER with significant MR reduction. Subsequent LAAO was challenged by suboptimal alignment with the appendage. The use of a steerable introducer restored coaxiality, allowing stable device delivery and successful deployment of a 24-mm occluder with complete sealing and no peri-device leak.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>This case demonstrates the feasibility of a combined one-stop strategy in frail patients at high procedural risk. It highlights the importance of procedural planning and the role of steerable delivery systems in overcoming anatomical constraints imposed by a mitral-oriented transseptal puncture, thereby facilitating successful completion of both interventions in a single session.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ehjcr\/ytag622","type":"journal-article","created":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T11:21:37Z","timestamp":1788348097000},"source":"Crossref","is-referenced-by-count":0,"title":["Single-session combined mitral transcatheter edge-to-edge repair and left atrial appendage occlusion using a steerable introducer after a mitral repair-oriented transseptal puncture: a case report"],"prefix":"10.1093","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8069-592X","authenticated-orcid":false,"given":"Michela","family":"Bonanni","sequence":"first","affiliation":[{"name":"Department of Cardiology, San Giovanni Evangelista Hospital , Tivoli 00019 ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matteo","family":"Pelliccia","sequence":"additional","affiliation":[{"name":"Department of Cardiology, San Giovanni Evangelista Hospital , Tivoli 00019 ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-3026-8855","authenticated-orcid":false,"given":"Giorgio Maria","family":"De Sanctis","sequence":"additional","affiliation":[{"name":"Department of Cardiology, San Giovanni Evangelista Hospital , Tivoli 00019 ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carmine","family":"Musto","sequence":"additional","affiliation":[{"name":"Department of Cardiology, San Giovanni Evangelista Hospital , Tivoli 00019 ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,9,2]]},"reference":[{"key":"2026090315234288500_ytag622-B1","doi-asserted-by":"crossref","first-page":"101541","DOI":"10.1016\/j.jacadv.2024.101541","article-title":"Outcomes of combined left atrial appendage occlusion and transcatheter mitral edge-to-edge repair: the WATCH-TEER study","volume":"4","author":"Al-Abcha","year":"2025","journal-title":"JACC Adv"},{"key":"2026090315234288500_ytag622-B2","doi-asserted-by":"crossref","first-page":"197","DOI":"10.3390\/jpm15050197","article-title":"One-stop mitral valve transcatheter edge-to-edge repair and left atrial appendage occlusion in patients with atrial fibrillation and mitral regurgitation: a systematic review and meta-analysis","volume":"15","author":"Pamporis","year":"2025","journal-title":"J Pers Med"},{"key":"2026090315234288500_ytag622-B3","doi-asserted-by":"crossref","first-page":"ytad592","DOI":"10.1093\/ehjcr\/ytad592","article-title":"Use of a steerable delivery sheath to obtain coaxial alignment in left atrial appendage occlusion after mitral transcatheter edge-to-edge repair: a case report","volume":"8","author":"Maiani","year":"2024","journal-title":"Eur Heart J Case Rep"},{"key":"2026090315234288500_ytag622-B4","doi-asserted-by":"crossref","first-page":"3314","DOI":"10.1093\/eurheartj\/ehae176","article-title":"2024 ESC guidelines for the management of atrial fibrillation developed in collaboration with the European association for cardio-thoracic surgery (EACTS)","volume":"45","author":"Van Gelder","year":"2024","journal-title":"Eur Heart J"},{"key":"2026090315234288500_ytag622-B5","doi-asserted-by":"crossref","first-page":"4635","DOI":"10.1093\/eurheartj\/ehaf194","article-title":"2025 ESC\/EACTS guidelines for the management of valvular heart disease","volume":"46","author":"Praz","year":"2025","journal-title":"Eur Heart J"}],"container-title":["European Heart Journal - 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