Transapical Edge-to-Edge Repair for Systolic Anterior Motion in Obstructive Hypertrophic Cardiomyopathy

Transapical mitral valve edge-to-edge repair (TA-TEER) offers a therapeutic option for obstructive hypertrophic cardiomyopathy with severe mitral regurgitation and systolic anterior motion. In this case series, we present 3 elderly patients with obstructive hypertrophic cardiomyopathy who underwent TA-TEER after declining conventional surgical options. Patient 1: A 66-year-old woman achieved immediate resolution of mitral regurgitation and systolic anterior motion, but developed hemolysis and hypotension at 2 weeks, requiring mechanical valve replacement. Patient 2: A 65-year-old man showed sustained improvement with resolved mitral regurgitation and systolic anterior motion at 4-month follow-up. Patient 3: A 70-year-old woman demonstrated immediate resolution with stable results. TA-TEER successfully addressed mitral regurgitation and systolic anterior motion in all cases, though 1 patient experienced serious complications requiring reoperation. Although TA-TEER may serve as a salvage option for high-risk patients, careful patient selection and awareness of potential complications are essential.