MitraClip Mitral Valve Repair

Mitral regurgitation, colloquially referred to as a leaking heart valve, is a common condition that affects patients with heart disease. When the mitral valve fails to close completely, blood may flow back into the heart, with potentially serious ramifications.

The most common symptoms of mitral valve regurgitation include

• shortness of breath
• dizziness
• rapid heartbeat and
• general fatigue.

Depending on a patient’s unique circumstance and the severity of the mitral valve regurgitation, there are several possible treatments. Some patients will be put on watchful waiting where no treatment is commenced immediately. Others may require medication. Severe cases may require surgery to avoid enlargement of the heart due to added strain, which may ultimately result in heart failure.

However, not all patients will be healthy enough for open heart surgery to fix the valve.

How MitraClip Helps

The MitraClip procedure represents a less invasive option for eliminating leakage and regurgitation through the mitral valve. Since it does not require open heart surgery, the perioperative and postoperative risks of the procedure are significantly reduced. The procedure is performed with only a small incision in the groin through which a catheter is threaded up a blood vessel and to the heart. A transseptal puncture is used to access the left side of the heart and the mitral valve. The entire process is performed and monitored by a specially trained interventional cardiologist using fluoroscopy or continuous x-ray to guide the catheter.

The catheter serves as a channel and delivery system for the MitraClip, which is then precisely positioned and ultimately deployed at the leaking valve. Once deployed, the surgeon will check to see if the leak has been fixed. If not, the clip can be repositioned for greater effectiveness. Once satisfied, the surgeon will secure the clip and the catheter is withdrawn from the body.

While the MitraClip is very effective at reducing regurgitation, especially in experienced hands, there is the possibility that more than one clip may be required to achieve full closure.

Benefits of MitraClip

While this is a relatively new procedure and we do not have extensive long-term data in the United States, results have been very positive and include:

• A viable option for those with high surgical risk
• The reduction or elimination of mitral regurgitation in most patients
• Improvement in the symptoms of mitral valve regurgitation and return to a better quality of life
• Improvement in the size and shape of the heart

Risks and Considerations of MitraClip

Because of the minimally invasive nature of the procedure, risks are reduced in high surgical risk patients when compared to open heart surgery. However, there are still risks associated with this procedure.

• Small risk of damage to blood vessels or infection at the incision site
• Small risk of damage to heart structures
• Rarely, the transseptal puncture does not heal on its own, requiring a follow-up procedure
• Very rarely, a patient may experience a stroke during the procedure.

Recovery and Aftercare

The entire procedure takes between two to three hours and patients will spend two to three nights in the hospital. Since patients undergoing this procedure have serious health concerns, they will be closely monitored during their recovery period.

Downtime is minimized because the closure device is secured in place and begins working from the moment it is implanted. Most patients return to normal activity within a few days to a couple weeks after discharge. Patients should take all wound care precautions to ensure that the small incision at the groin does not become infected. Patients will typically follow up with their cardiologist within 1 to 2 weeks after the procedure.

The MitraClip has a great deal of clinical and anecdotal evidence behind its effectiveness – it has been performed in Europe thousands of times and is gaining momentum in the United States as well. Currently, patient selection is restricted to those with high surgical risk and severe regurgitation. As results of the procedure are collected, these restrictions may be loosened and more patients will become eligible. In the meantime, this offers an excellent, safer option to open heart surgery for high-risk patients that qualify.