What is Mitral Regurgitation (MR)?

• Mitral regurgitation occurs when the mitral valve, located between the left atrium and left ventricle, does not close completely during the contraction of the heart. This improper closure allows blood to flow backward into the left atrium, reducing the heart’s efficiency and causing symptoms like:
  • Shortness of breath
  • Fatigue
  • Swelling in the legs
  • Heart palpitations
• MR can be caused by a variety of conditions, including degenerative mitral valve disease, functional MR due to heart enlargement, or damage from a heart attack.

What is the MitraClip?

The MitraClip is a small, flexible device that is inserted into the heart using a catheter-based approach. It is used to clip together the two leaflets of the mitral valve, which reduces the amount of blood leaking back into the left atrium. The goal of the procedure is to improve heart function, alleviate symptoms, and improve the patient’s quality of life.

How Does the MitraClip Procedure Work?

The MitraClip procedure is minimally invasive and typically performed under general anesthesia. It involves the following steps:

1. Access:
   • A catheter is inserted into the femoral vein (the large vein in the groin) and is advanced toward the heart. In some cases, access may be gained through the neck veins.
   • The procedure is guided by transesophageal echocardiography (TEE) or fluoroscopy (X-ray) to allow the cardiologist to precisely navigate the catheter to the mitral valve.
2. Device Insertion:
   • Once the catheter reaches the heart, the MitraClip device is delivered to the mitral valve.
   • The MitraClip is positioned between the two leaflets of the mitral valve.
   • The device is then deployed, and the two leaflets are clipped together. This creates a “tighter” seal that reduces the amount of blood that leaks backward into the left atrium.
3. Final Check:
   • After the MitraClip is deployed, additional imaging is used to confirm that the mitral valve is working properly and that the leak has been reduced.
   • The catheter is then removed, and the procedure is complete.
4. Post-Procedure Monitoring:
   • Patients typically stay in the hospital for one or two days to monitor for any complications, such as bleeding or arrhythmias.
   • Patients are often started on blood-thinning medication to prevent blood clots from forming around the MitraClip device.

Benefits of the MitraClip Procedure:

• Minimally invasive: Unlike traditional mitral valve surgery, which requires open-heart surgery, MitraClip is performed through a small incision and does not require chest opening. This results in less pain and faster recovery.
• Reduced risk: The procedure has a lower risk compared to traditional surgery, making it a good option for high-risk patients who may not be candidates for open-heart surgery.
• Improved symptoms: The procedure can significantly reduce symptoms of mitral regurgitation, such as shortness of breath, fatigue, and exercise intolerance, improving the patient’s quality of life.
• Faster recovery: Since the procedure is minimally invasive, patients typically experience a quicker recovery time compared to traditional surgery, allowing them to return to normal activities sooner.

Who is a Candidate for MitraClip?

MitraClip is typically recommended for patients who:

• Have severe symptomatic mitral regurgitation that does not improve with medication or other treatments.
• Are considered high-risk surgical candidates for traditional mitral valve repair or replacement due to factors like age, frailty, or other serious health conditions.
• Are experiencing significant heart failure symptoms due to mitral regurgitation.
• Have been evaluated by a heart team (cardiologists and surgeons) and are determined to be appropriate candidates for the procedure.

Risks and Potential Complications:

While the MitraClip procedure is generally safe, there are potential risks and complications, including:

• Bleeding: As with any procedure involving catheter insertion, there is a small risk of bleeding at the insertion site or internally.
• Infection: There’s a slight risk of infection where the catheter was inserted or around the MitraClip device itself.
• Blood clots: Formation of blood clots on or around the MitraClip device can occur, potentially leading to a stroke or other complications.
• Device-related complications: There is a possibility of device malposition or migration, which may require further intervention.
• Valve malfunction: In some cases, the MitraClip may not sufficiently reduce the mitral regurgitation, or the mitral valve may continue to leak, requiring additional treatments or even surgery.

Outcomes and Prognosis:

• Symptom improvement: Most patients experience significant improvement in symptoms, such as reduced shortness of breath and increased exercise tolerance.
• Long-term benefits: Studies have shown that MitraClip can significantly improve quality of life and reduce hospitalizations for heart failure in patients with severe symptomatic mitral regurgitation.
• Longevity of results: While the MitraClip device is effective in reducing mitral regurgitation in the short to medium term, there is ongoing research to assess the long-term durability of the device. Many patients experience sustained benefits over several years, though regular follow-up and imaging are necessary to monitor valve function.