MitraClip

(Also called: Transcatheter mitral valve repair)
Purpose 

3-D echocardiogram showing the mitral valve (blue area, centre) and the Mitraclip (circled) The mitral valve is a one-way valve located between the heart’s two left chambers and allows blood to flow from the atrium to the ventricle. It has two leaflets, or flaps, that open and close to ensure blood flows in only one direction. When the mitral valve does not close properly, blood is allowed to leak backwards in the heart. This is called mitral regurgitation (MR). 

This causes the heart to work harder to push blood through the body. Common symptoms caused because of this increased work load are fatigue, shortness of breath, coughing, an irregular heartbeat and swollen feet or ankles.

MR is a progressive disease which can eventually decrease your quality of life and result in increased difficulty performing your regular daily activities.

Depending on your current health condition, and the severity of your symptoms, your doctor may refer you to the MitraClip team for further assessment.

Patient Evaluation

Not everyone is a candidate for the MitraClip device. It is only applicable to a limited group of patients with a certain anatomy and type of mitral regurgitation. For the majority of patients with leaky mitral valves, the MitraClip is not a preferred therapy and should be treated with traditional surgical methods. 

The goal of treatment is to decrease the mitral regurgitation and improve your quality of life.

The current standard of care for treating severe MR is to perform open heart surgery. This can be done by either replacing the mitral valve with an artificial valve (mitral valve replacement) or fixing your own valve (mitral valve repair). In both cases, open heart surgery is the most effective and well proven way to cure severe mitral regurgitation. However, not all patients are candidates for open heart surgery.

The MitraClip procedure is a less invasive, catheter-based treatment that is performed in the cardiac catheterization laboratory. The MitraClip procedure is an alternative to medical treatment for people who are not eligible for open heart surgery because it is considered too high risk for them.  

Patients referred for this procedure must undergo a transesophageal echocardiogram (TEE) at the University of Ottawa Heart Institute. This will provide the MitraClip team with specific measurements of your mitral valve.

Once the TEE has been completed, you will be seen in clinic by either an interventional cardiologist who specializes in catheter-based technologies; or by a cardiac surgeon who specializes in mitral valve repair. A physical assessment will be completed at this time.

Not all patients are candidates for the MitraClip procedure. You may be better served by open heart surgery or by continuing with your medical therapy. Your treatment pathway will be discussed with you at this time.

Description 

1. The MitraClip procedure is performed in a cardiac catheterization lab, not in the cardiac operating room. 

2. Patients receive a general anesthetic and will be asleep for the procedure.

3. Insertion of the MitraClip is done with the use of a catheter which is inserted through the femoral vein in the groin, and guided to the right side of the heart.

4. A tool on the tip of the catheter is used to make a small puncture through the upper chambers of the heart (the atria) to reach the left side of the heart where the mitral valve is located. This is done by using both ultrasound and X-ray pictures to guide the tool into place.

5. The MitraClip is then inserted through the catheter and positioned using ultrasound at the leaking portions of the mitral valve.  It is not uncommon to use two MitraClips to fix the leaky valve. 

6. The clip (or clips) will be attached to the mitral valve leaflets, holding them firmly together. Once clipped, the valve’s leaflets will open and close together in a more normal way with each heartbeat. This will reduce the amount of blood being leaked backwards in the heart. 

The average length of hospital stay post-procedure varies anywhere from one day to one week and depends on the current status of your health.

Additional Info 

For more information, please contact the MitraClip Coordinator at 613-761-4742.

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