A new procedure to treat mitral regurgitation: MitraClip®
Patients with heart failure caused by mitral regurgitation can experience a better quality of life thanks to MitraClip®.
Mitral regurgitation (MR) is a leakage of blood flowing backwards through the mitral valve each time the left ventricle contracts. The leaking valve causes blood to flow the wrong way - back into the left atrium. This makes the heart work harder to push blood around the body.
Patients may experience fatigue, shortness of breath and worsening heart failure. MR can also put further pressure on the pulmonary vessels and in severe cases, this can result in congestion in the lungs.
Repairing the mitral valve
Mitral valve repair or replacement is a procedure normally requiring open heart surgery which, in older or frailer patients, can be associated with a higher risk and longer recovery time.
The MitraClip®, from Abbott Vascular, is a relatively new ‘keyhole’ technique that offers a less invasive approach compared to conventional surgery. The procedure does not require cardiopulmonary bypass and is performed on the beating heart.
A transcatheter procedure
With MitraClip, the mitral valve is repaired through a catheter inserted through the top of the patient’s leg and via the femoral vein.
Once the catheter is guided to the heart, a small hole is made to enable the catheter to cross from the right to the left side of the heart. The MitraClip is then steered into the left atrium. This small device is then used to literally ‘clip’ the leaking portions of the valve leaflets together.
The procedure usually takes between two and three hours and patients are normally discharged from the hospital after a couple of days.
Evidence-based new treatment
Royal Brompton & Harefield Hospitals are the most experienced MitraClip centre in the UK, having undertaken more than 140 cases to date. That's more than double any other UK Trust. The MitraClip team is led by consultant interventional cardiologist Dr Robert Smith.
At present, MitraClip is used to treat leaking mitral valves in patients unable to have open heart surgery and in patients with heart failure and associated ‘functional’ or secondary MR.
In international randomised trials, MitraClip treatment has been proven to reduce MR, provide a faster recovery for patients and improve their quality of life. The EVEREST trials demonstrated that MitraClip was safe and effective when compared to conventional open-heart surgical repair. The benefit was maintained and still clear at five years in the most recent landmark publication.
1. Randomized Comparison of Percutaneous Repair and Surgery for Mitral Regurgitation: 5-Year Results of EVEREST II. Feldman T et al (2015), EVEREST II Investigators. Journal of the American College of Cardiology. Dec 29;66(25):2844-54.
