Percutaneous Mitra Clip implantation is a minimally invasive procedure used to treat mitral regurgitation (MR)—a condition where the mitral valve does not close properly, causing blood to leak backward into the left atrium. The MitraClip procedure offers a safe and effective alternative to open-heart surgery, especially for patients who are at high surgical risk.
What is Mitral Regurgitation?
Mitral regurgitation occurs when the mitral valve (located between the left atrium and left ventricle) fails to close completely, causing:
- Blood to flow backward into the left atrium
- Symptoms like fatigue, shortness of breath, and palpitations
- Over time, it may lead to heart failure if untreated
Types of Mitral Regurgitation
- Primary (Degenerative MR): Caused by structural abnormalities of the mitral valve itself (e.g., prolapse, flail leaflet)
- Secondary (Functional MR): Resulting from left ventricular dysfunction or dilation pulling the mitral valve apart
What is Percutaneous MitraClip?
The MitraClip is a small, clip-like device implanted via catheter to grasp and bring together the mitral valve leaflets, reducing the backflow of blood. It mimics the surgical “edge-to-edge” repair technique.
This transcatheter mitral valve repair (TMVr) approach is performed without opening the chest or using a heart-lung machine.
Indications for MitraClip Implantation
Who is Eligible?
MitraClip is typically recommended for patients who have:
- Severe symptomatic mitral regurgitation
- Are considered high or prohibitive risk for open-heart surgery
- Failed medical management or are not candidates for valve replacement
Clinical Conditions Suitable for MitraClip
- Primary MR with high surgical risk
- Secondary MR in heart failure patients (based on COAPT trial)
- MR after prior mitral repair surgery or devices
How is MitraClip Implantation Performed?
Step-by-Step Procedure
- Pre-procedural Evaluation
- Transthoracic and transesophageal echocardiography
- Cardiac catheterization and other imaging studies
- Procedure Day
- Performed under general anesthesia
- A catheter is inserted through the femoral vein and guided to the left atrium via a transseptal puncture
- Clip Deployment
- The MitraClip device is guided into position using real-time 3D echocardiography and fluoroscopy
- The clip grasps the mitral valve leaflets to reduce the regurgitation
- If needed, more than one clip can be implanted
- Final Assessment
- Mitral regurgitation is re-evaluated
- Once satisfactory, the delivery system is withdrawn and the puncture site is closed
Advantages of MitraClip
- Minimally invasive – no chest incision
- Faster recovery time
- Improved quality of life
- Reduced hospital readmissions for heart failure
- Especially useful for frail or elderly patients
Risks and Limitations
While MitraClip is generally safe, potential risks include:
- Bleeding or vascular complications at the access site
- Incomplete MR reduction
- Need for further procedures or surgery
- Device malfunction (rare)
- Stroke or infection
Recovery and Follow-Up
- Most patients are discharged in 1–3 days
- Resume daily activities within a week
- Medications may include antiplatelets or anticoagulants
- Echocardiographic follow-up to monitor valve function
- Continued heart failure management and lifestyle changes
Clinical Outcomes
Success Rate
- Immediate procedural success in 95–99% of patients
- Significant reduction in MR severity
- Improved exercise tolerance and NYHA heart failure class
- Reduction in hospitalizations and mortality (especially in functional MR per COAPT study)
Final Thoughts
Percutaneous MitraClip implantation is a transformative treatment for patients with severe mitral regurgitation who are not suitable for surgery. With a high success rate and low complication risk, MitraClip provides symptom relief, improved cardiac function, and enhanced quality of life.
