Leaky mitral valves fixed with MitraClip®
The transcatheter mitral valve repair (TMVR) programme at Royal Brompton and Harefield hospitals is one of the most experienced and comprehensive in the world. Dr Robert Smith has treated more than 150 leaky mitral valves with MitraClip therapy.
Here, he discusses the benefits of this procedure.
Human heart valves are exceptional structures. The mitral valve, in particular, is very complex with thin valve leaflets attached to the heart wall via multiple string-like chords. Opening with every heartbeat, millions of times over a lifetime, the valve is susceptible to wear and tear.
What is mitral regurgitation?
As the heart beats, the mitral valve and tricuspid valve control blood flow from the atria to the ventricles. If the mitral valve’s two leaflets do not close completely then this allows blood to flow backwards at high pressure through the valve into the left atrium.
This is known as mitral regurgitation (MR), and it causes the heart to work harder to push blood around the body. Patients may experience symptoms such as fatigue, shortness of breath and worsening heart failure. It can also put further pressure on the pulmonary vessels, and in severe cases, this can result in fluid congestion of the lungs.
Mitral regurgitation can be related to age, coronary artery disease, underlying heart muscle disease (cardiomyopathy) or birth defect.
Treating the leaky valve
Mitral regurgitation can be successfully treated by experts at Royal Brompton & Harefield Hospitals Specialist Care. Conventionally, degenerative mitral regurgitation is treated by open heart surgery. However, in situations where the risk of surgery is too high, or when the regurgitation is ‘functional’ (i.e. due to a weak heart muscle), open heart surgery may not be appropriate.
Dr Robert Smith is a consultant interventional cardiologist who runs the most experienced MitraClip team in the UK.
The MitraClip device is a small clip that is attached to the mitral valve. It treats mitral regurgitation by allowing the mitral valve to close more completely, helping to restore normal blood flow through the heart.
As a transcatheter procedure, the MitraClip – created by Abbott Vascular – is a less invasive approach than conventional surgery. Access to the heart is via a small incision in the groin.
During the procedure to fit the device, a radiographer is on hand with an x-ray machine, to provide the images to guide the interventional cardiologist. In addition, another cardiologist guides a transoesophageal echocardiogram (TOE), which uses ultrasound from a probe to check the structure of the heart and how well it is functioning.
The procedure immediately reduces mitral regurgitation. Patients are likely to feel a change to their quality of life quickly afterwards, once the anaesthetic has worn off.
Dr Smith adds: “After 48 hours, they have a significant improvement. MitraClip is associated with symptomatic improvement in 90 to 95 per cent of patients. It’s proven to be good at relieving symptoms.”
“More recently, a major study – COAPT* – has demonstrated that MitraClip improves survival and reduces hospital admissions for functional mitral regurgitation.”
Recovery is faster than conventional surgery, and MitraClip patients usually only need to stay in hospital for a few days.
Heart failure symptoms are improved, and in the longer term, MitraClip is shown to reduce the number of hospital visits for heart failure.
A whole team of specialists
Dr Smith highlights the benefit of being treated by an experienced multidisciplinary team at Royal Brompton and Harefield hospitals:
We are a world-leading transcatheter mitral clip service. We are the most experienced unit in the country by a long way. We have now done more than 230 MitraClip procedures.”
“For private patients, you are not just getting me as a consultant – you’re getting a whole team. I work closely in a team with surgeons, cardiologists, anaesthetists and nurses.”
One of those nurses is clinical nurse specialist, Lauren Kelly, who second operates with Dr Smith. Lauren coordinates all MitraClip patients, by liaising with them and booking them in. Patients have direct contact with her in the run-up to the procedure, and can speak to her directly on the phone.
The open nature of communication means that patients are fully prepared for their procedure and they understand what is going on.
Echocardiogram images from the same patient
Left: Mitral valve with severe MR (pre-MitraClip)
Middle: Mitral valve with trivial MR and MitraClip in situ
Right: MitraClip attache to the anterior and posterior leaflets
*Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients with Functional Mitral Regurgitation (COAPT)
Refer a patient for MitraClip
As the most experienced transcatheter MitraClip service in the UK, the team at Royal Brompton & Harefield Hospitals Specialist Care accepts private patients referrals from cardiologists, as well as self-referrals.