Mitral Valve Clip Procedure: Everything You Need to Know

The mitral valve clip, known as MitraClip for short, is a minimally invasive, non-surgical alternative used to repair a damaged mitral heart valve. The mitral valve clip procedure significantly improves heart function in those with mitral regurgitation by improving the function of your mitral valve. The mitral valve clip procedure has been a lifeline for many patients seeking non-surgical alternatives to open heart surgery mitral regurgitation, the second leading cause of valvular heart disease in the United States behind aortic stenosis.

What Is Mitral Valve Clip Procedure?

The mitral valve clip procedure is a way to repair your mitral heart valve without open heart surgery. Although this option was originally adopted for patients who were too sick or too high risk for open heart surgery, many people who are experiencing mild to moderate symptoms of mitral regurgitation choose to have this procedure.

The procedure is performed percutaneously, which means the doctor accesses your heart through a vein, usually the groin. A small metal clip coated in polyester fabric, the mitral valve clip device, is inserted in the leg and guided by a long, flexible tube called a catheter up to your mitral valve.

The clip is attached to two areas of the defective valve, in what doctors call an ‘edge-to-edge’ repair. This allows for greater blood to flow in the right direction. Although a mitral valve clip may significantly reduce mitral valve regurgitation, sometimes called mitral valve insufficiency, it rarely eliminates the condition altogether, although patients may report a significant reduction in their symptoms a few days after the procedure is performed.

The mitral valve clip procedure is usually scheduled and performed in an outpatient setting. The entire procedure usually lasts between 1 to 3 hours, although it can take longer depending on the complexity of the case.

Contraindications

The mitral valve clip procedure is generally a safe choice even for high-risk surgical candidates. Unfortunately, some people are not candidates for the mitral valve clip procedure. Most doctors believe that the traditional open heart procedure is best for those with severe mitral regurgitation symptoms. It is important to note that the mitral valve clip is not a curative treatment so for more severe cases, surgical repair or replacement is a better option.

The mitral valve clip is also contraindicated in those who cannot tolerate anticoagulation during or after the procedure. Further contraindications include:

• Having an infection on the mitral valve such as active endocarditis of the mitral valve or rheumatic mitral valve disease.
• Evidence of intracardiac, inferior vena cava, or femoral venous thrombus that would make it impossible to deliver the device via the long thin catheter tube needed to get the mitral valve.

Potential Risks 

The mitral valve clip procedure is generally considered safe but like all medical procedures, there are potential risks. Two procedural complications include:

• Vascular complications: While advancing the mitral valve clip device, the force applied in the groin may damage the femoral artery.
• Dislocation of an existing pacemaker: Even those with moderate mitral regurgitation may require defibrillators or resynchronization therapy implantation. Surgeons must be careful not to displace these devices while advancing the clip into the right atrium of the heart.

There may also be complications related to the implantation of the clip. The two most frequent complications are:

• Single-leaflet device attachment (SLDA): This is the most frequent complication and may occur up to 5% of the time. SLDA is when the clip remains attached to one leaflet of the mitral valve after its placement. SLDA is normally quickly repaired because it is recognized during or just after surgery, but it can occur even a month after surgery.
• Clip embolization: This occurs when the clip detaches. This is extremely rare and currently there are no guidelines as to how to repair this other than to perform surgery to remove the clip if it winds up in an area that is dangerous or harmful to the body.

Purpose of Mitral Valve Clip Repair Procedure

When your mitral valve doesn’t close properly, blood can flow backward from the left ventricle to the left atrium and eventually the lungs. The defective valve does not shut tightly hence the term mitral valve insufficiency. The medical condition that occurs as a result of an insufficient or defective heart valve is mitral regurgitation.

Backflow of blood to the lungs can lead to symptoms of dizziness, shortness of breath, swelling of the legs and feet called edema, and fatigue. If left untreated, mitral regurgitation can lead to an irregular heartbeat, chest pain, and even heart failure.

The mitral valve clip procedure is now widely considered a first-line treatment for patients who are too high risk for surgery. Some of the benefits are:

• Shorter recovery time
• Minimally invasive
• Significantly less pain than open heart surgery
• Life-saving option for those who are at the highest surgical risk

If you are undergoing the mitral valve clip procedure you must report all the medications that you are taking to avoid serious complications or drug-drug interactions. Your doctor may also ask you to take certain heart tests like an echocardiogram, EKG, and X-ray to assess your heart's functioning prior to performing the procedure.

How to Prepare

Most mitral valve clip procedures happen in the cath lab in a hospital or in an ambulatory or outpatient setting under general anesthesia. Higher risk patients usually require an overnight stay in the hospital where the procedure is performed. Bringing a change of clothes is suggested for those who are required to stay overnight.

An overnight stay is usually to monitor for complications since the procedure is relatively short and painless. Prior to your surgery, your doctor may ask you to hold off on taking certain medications like aspirin and anticoagulants that may interfere with surgery.

Recovery

Most people experience immediate relief of their mitral regurgitation symptoms after the procedure. Some patients can go home after a few hours of monitoring while others may have to stay a day or two based on their condition. Most patients will be discharged with medication instructions. 

After being discharged from the hospital, it is important that you:

• Limit strenuous physical activity: This includes jogging or activities that cause you to be short of breath for at least 30 days, or longer if your doctor thinks it is necessary
• Follow your doctor's instructions regarding medications: Pay close attention to medications you need to take, especially if blood-thinning drugs are prescribed
• Take note of any serious side effects: Call your doctor if you cannot keep taking your medications because of side effects, such as rash, bleeding, or upset stomach

If there are no complications and your work does not require strenuous activity, you can usually return within 72 hours of surgery. You may be asked to follow-up with your cardiologist or a primary care professional a week after surgery, but if your mitral regurgitation symptoms return before then, or at any point, notify a healthcare professional immediately.