MitraClip procedure
Severe forms of mitral valve regurgitation, i.e. leaky mitral valves, are treated using open heart surgery. While this has been regarded as the standard approach to treatment for many years, it poses too high a risk for some patients. In these cases, the MitraClip procedure may provide an alternative treatment approach.
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When should the MitraClip procedure be used?
Mitral valve regurgitation, i.e. leakiness of the mitral valve, is a very common type of heart disease. For many years, surgery has been widely established as the standard approach to treating severe forms of this condition, with surgical treatment including a number of options, ranging from mitral valve reconstruction to mitral valve replacement. Some patients may be at too high a risk of surgical complications, due to medical reasons such as severe concomitant disease, having previously undergone heart surgery or having received radiation therapy to the chest.
What is the MitraClip procedure?
The MitraClip procedure was developed based on the Alfieri stitch technique - a surgical valve reconstruction procedure, whereby the two edges of the valve leaflets are approximated by use of a suture in the middle of the leaflets.
It is a relatively new procedure, and has been performed at our Heart Center since 2009. Our hospital was among the first 5 German hospitals to start using this new form of treatment.
How does the MitraClip procedure work?
Using a special catheter-based delivery system, the MitraClip is inserted in between the two mitral valve leaflets without having to interfere with the normal pumping action of the heart. This procedure does not require the patient's chest to be opened, nor does it require the use of cardiopulmonary bypass (a heart-lung machine).
Instead, a catheter is inserted via the groin and advanced into the left side of the heart. Echocardiography is used to ensure the correct placement of the clip. This ensures that overall, the need for x-ray exposure is relatively low. As x-ray contrast agents are not usually required, this technique is also unproblematic in patients with severe kidney failure. The use of echocardiography (ultrasound) allows the clip to be positioned in the exact center of the leak.
![[Translate to Englisch:] MitraClip mit Device geöffnet - Immanuel Herzzentrum Brandenburg in Bernau bei Berlin](/assets/_processed_/6/c/csm_abbott-mitraclip-mit-device-geoeffnet-immanuel-herzzentrum-brandenburg-in-bernau-bei-berlin_77504755c9.webp "[Translate to Englisch:] MitraClip mit Device geöffnet - Immanuel Herzzentrum Brandenburg in Bernau bei Berlin")
Animation showing positioning of the MitraClip
The animation of the MitraClip procedure begins by providing a clear illustration of mitral regurgitation, i.e. a leak in the mitral valve that leads to heart failure. In contrast to what happens in a healthy valve, there is a backflow of blood from the left ventricle into the left atrium, which leads to a decrease in exercise capacity and shortness of breath.
The animation shows how the MitraClip is positioned inside the defective mitral valve using a catheter-based delivery device. The MitraClip is attached to the tip of the delivery system.
- Standard access: At the start of the procedure, the device catheter is inserted via the groin and advanced through the blood vessels until it reaches the right atrium.
- Septal crossing: Once inside the right atrium, the catheter is advanced through the septal wall and into the left atrium. The septal wall is only parted slightly to allow the catheter to pass. This means that the small gap can seal itself naturally after the end of the procedure.
- MitraClip device introduction: Once inside the left atrium, the introducer device is retracted and the MitraClip is advanced.
- Positioning: Using ultrasound guidance, i.e. electrocardiography, the MitraClip is positioned inside the left atrium and advanced towards the heart valve.
- The clip is opened and positioned directly above the area of the mitral valve responsible for the majority of the regurgitation.
- Grasping: The open clip is pushed through the valve, then retracted grasping the leaflets. Positioning can be checked and readjustments made.
- Once the clip has been positioned in such a way as to ensure elimination of regurgitation, the clip is closed. Proper positioning is assessed to ensure that blood can flow on both sides of the clip.
- Deployment: The MitraClip remains attached to the valve leaflets, effectively bridging the valve across its middle. The catheter is then removed, and the clip will remain attached to the mitral valve.
- Before – After: Comparison of mitral regurgitation before and after the procedure: Heart with mitral regurgitation on the left, heart with MitraClip on the right.
Follow-up treatment
After undergoing a MitraClip procedure, many patients will need to take blood-thinning medication, usually for around three months. No other specific medications will need to be prescribed. In fact, as symptoms improve, patients are often able to reduce the amount of medicine they were taking prior to the procedure.
Our Heart Failure Outpatient Clinic offers a special follow-up treatment program for patients who have had a MitraClip fitted. This allows us to monitor patients in terms of heart and mitral valve function, as well as allowing us to adjust medications as and when appropriate.
Follow-up visits are usually scheduled every three to six months, and include cardiac ultrasound testing, ECGs and blood tests, which are used to assess current heart function. Follow-up visits will also include an in-depth consultation with one of our cardiac specialists. We are of course always available to answer any questions that your general practitioner or local cardiology specialist may have
Treatment results
Having successfully performed a total of 150 procedures, we have become one of the leading specialist centers in Germany offering this new treatment approach. Nearly all of our patients were able to be treated successfully with the MitraClip procedure, without the need for any additional surgical procedures involving the heart. The close cooperation that exists between our Interventional Cardiology and Cardiac Surgery Departments means that we are able to respond without delay should complications arise, and result in a patient requiring emergency cardiac surgery.
Where can I find more information about the MitraClip procedure?
General information on heart disease
Die Deutsche Herzstiftung (German Heart Foundation):
Information on cardiovascular research
Deutschen Gesellschaft für Kardiologie – Herz- und Kreislaufforschung e.V. (German Cardiac Society)
dgk.org
Specialist article
Butter C., PD (Co-Autor), Mitraclip therapy in patients with end-stage systolic heart failure, Eur J Heart failure 2011;13;569-76