The MitraClip therapy is used to treat mitral regurgitation.
What is Mitral Regurgitation?
Mitral Regurgitation (MR) is a condition in which the heart’s mitral valve does not close tightly enough. This lets some of the blood in your heart "regurgitate," or flow backward, into your heart chambers. Your heart contains four valves. They are key to the proper flow of blood through the heart. The mitral valve is on the left side of your heart and controls blood flow from the atrium to the ventricle. This valve has two leaflets that open and close to ensure blood travels in only one direction within the heart.
In people with MR, the mitral valve doesn’t seal completely and blood leaks backward. As a result, the heart must work harder to push blood through the body. Common symptoms caused by this increased workload include fatigue, shortness of breath, coughing, an irregular heartbeat, and worsening heart failure. MR is a progressive disease that can eventually impact your quality of life and make daily activities more difficult.
Therapy options for treating mitral regurgitation
The goal of treatment is to decrease the mitral regurgitation and improve your quality of life.
Medications may be prescribed to help reduce the symptoms you experience, but they cannot fix the valve itself.
Open heart surgery
If you are very ill or have many other medical problems, open heart surgery may be considered too high risk.
Your eligibility for this procedure will be decided by a specialized team, including a cardiologist experienced in percutaneous (catheter-based) procedures, a cardiac surgeon experienced in valve repair, and a cardiac anesthesiologist experienced in the complex management of patients during these procedures.
If your cardiologist or internist diagnosed you with severe MR after seeing the results from a transthoracic echocardiogram (TTE), along with your condition, you will need a consultation with the MitraClip team.
You will need to undergo another test, a transesophageal echocardiogram (TEE) to provide the team with the specific measurements of your mitral valve. With this information, the MitraClip team will discuss your case to make sure you are getting the right procedure, at the right time, along with the best care before and after your procedure.
What is the MitraClip procedure?
Over the past few years, the MitraClip device has been used in many patients to correct blood flow through the mitral valve without open heart surgery. The MitraClip procedure is performed in a cardiac catheterization lab, not in the cardiac operating room. This procedure is done by use of a catheter that is inserted through a needle hole (percutaneously, or via the skin) in the groin. The catheter—a long, flexible tube—is inserted into a large vein in your groin (femoral vein) and guided to your heart. It is positioned using ultrasound and X-ray images.
Once the tip of the catheter has reached your heart, your mitral valve is assessed using a transesophageal echocardiogram. The TEE also aids in the correct placement of the MitraClip. A tool on the tip of the catheter makes a tiny hole through the upper chambers (atria) of the heart so that the catheter can be inserted and guided to the left side, where the mitral valve is located. Through the catheter, the MitraClip is then inserted and positioned by ultrasound to the leaking portions of the valve. The clip is attached to the mitral valve leaflets, fastening them firmly together and allowing the valve to close better. It is not uncommon for two MitraClips to be used to fix a severely leaky valve. You will be given general anesthetic so that you will be asleep during the entire procedure.
The advantage of this procedure is that it is less invasive than open heart surgery and may reduce the amount of recovery time. The small puncture in your groin, where the catheter is inserted, heals quickly. This is a reasonable alternative to medical treatment (i.e., medications) for patients who are not candidates for open heart surgery (such as the very old and frail, patients with very weak hearts and those who have other non-cardiac conditions involving the lungs, kidneys or brain). Patients who have had previous open heart surgery are also considered for the MitraClip procedure because they may be at higher risk for a re-operation.
After you receive the MitraClip procedure
You will need someone to drive you home on the day of your discharge from the hospital. Make plans to have someone stay with you for the first night or two after you get home.
- Do not take a bath, sit in a hot tub, or go swimming until your physician says it is OK. We do not want the access site to get infected. It is OK to shower.
- Do not lift anything that weighs more than 10 pounds for one week (a gallon of milk weighs almost nine pounds).
- You can walk and do any activities that do not require heavy lifting, pushing or pulling.
- Do not do any vigorous activities until your physician says it is OK.
- You may drive if you were doing so before the procedure.
Access Site Care
The access site for the procedure is a small puncture site in your groin area. Keep the access site clean and dry. You do not need to apply any special dressings (bandages).
For the first six months after your procedure, you will need to take antibiotics before any dental work, to prevent infection of the heart.
If you are on warfarin (Coumadin), you will have a Protime/INR text within one week after discharge.
You must also have follow-up visits:
- Two weeks after discharge with our nurse practitioner.
- Thirty days after discharge with your cardiologist. This visit will include an echocardiogram (ultrasound of the heart).
- Once a year with your cardiologist.