Just 10 years ago, patients with mitral valve regurgitation who could not undergo open heart surgery had no other treatment options.
Now, a procedure called transcatheter edge-to-edge repair (TEER), is giving those patients a minimally invasive option for mitral regurgitation (MR) repair. The procedure is available at UPMC using the MitraClip®.
Minimally invasive procedures typically have less scarring, lower risk of infection, and quicker recovery times than open procedures.
What Is the Mitral Valve?
The mitral valve is one of four valves in the heart. It regulates blood flow from the upper left chamber (left atrium) into the lower left chamber (left ventricle). The left ventricle is the heart’s main pumping chamber.
Mitral valve issues are usually the result of:
- Being born with a floppy mitral valve.
- Having had rheumatic fever.
- Receiving a chest injury.
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What Is Mitral Regurgitation?
A normal mitral valve stops blood from flowing backward toward the left ventricle when the heart contracts. A leaking mitral valve lets blood flow in two directions during each contraction. Some blood flows forward from the ventricle through the aortic valve, as it should. But some also leaks or regurgitates backward into the left atrium, a condition called mitral regurgitation (MR).
When MR is mild, there may be no symptoms. But leakage from MR can increase blood volume and pressure in the left atrium. This may increase pressure in the pulmonary veins leading from the lungs to the heart. Severe MR can cause fluid to build up in the lungs.
Also, when MR is more severe, the person might develop heart palpitations due to an irregular heart rhythm called atrial fibrillation (Afib). Afib puts people at increased risk of blood clots and stroke.
If MR is very severe, the heart may enlarge to maintain forward flow of blood. This can cause heart failure, a condition where the heart cannot pump enough blood to the body. Heart failure can produce symptoms including:
- Shortness of breath during exertion.
- Congestion around the heart and lungs.
- Edema (swelling) of the legs and feet.
There are many reasons why a person may have MR. They may have been born with a normal valve but had a heart attack, chest injury, or other heart condition that damaged or ruptured the mitral valve.
Mitral valve prolapse — a condition that can develop in people of any age but tends to occur most often in men over age 50 — is a common cause of MR. It tends to be hereditary, meaning it runs in the family genetically. It may be linked to several other conditions, including:
- Ebstein’s anomaly.
- Ehlers-Danlos syndrome.
- Graves’ disease.
- Marfan syndrome.
- Muscular dystrophy.
Mitral Valve Prolapse
The most common reason for MR is mitral valve prolapse (MVP), a type of heart valve disease in which the leaflets or flaps of the mitral valve are floppy. The leaflets prolapse or bulge backward like a parachute into the left atrium each time the heart contracts. Over time, if left untreated, it can cause a snowball effect of issues leading to heart failure and death.
Mitral Valve Prolapse Treatment
“Open heart surgery is the gold standard for repair of mitral valve prolapse,” says Katie Fatigante, PA-C, a physician assistant at UPMC Center for Heart Valve Disease. “For patients whose comorbidities exclude open heart surgery as an option, the MitraClip® procedure has shown great success in reducing the leakiness of the valve and improving their quality of life.”
Comorbidities are other health conditions that increase the risk of certain procedures or medications. Comorbidities that may make open heart surgery too risky include:
- Chronic obstructive pulmonary disease (COPD).
- Kidney disease.
- Mobility issues.
- Advanced age.
What Is Minimally Invasive MR Repair?
The minimally invasive transcatheter edge-to-edge repair (TEER) procedure is an option for patients who aren’t candidates for open heart surgery. An interventional cardiologist performs the procedure in the cardiac catheterization laboratory.
While the patient is under general anesthesia, the doctor makes a small incision in the groin. They then advance a catheter through the big vein in the leg into the left ventricle of the heart.
Using a transesophageal echocardiogram for guidance, the doctor advances the steerable catheter containing the MitraClip® past the faulty mitral valve. The catheter is positioned below the valve to catch the leaflets, then clipped to grip the leaflets. This creates an opening with two smaller holes.
The nimble catheter system can open and close the MitraClip® for perfect positioning. Then the device is released and retracted, leaving the MitraClip® in place. Over time, tissue growth on the clip creates a fibrous tissue bridge, sealing the leaky leaflets.
Who is a candidate for TEER?
“The MitraClip® procedure may be right for some patients who can’t undergo surgery because it can get them back to improved function in less time, with fewer complications,” Fatigante says.
“Because it’s a small incision, there is less chance of infection. The patient is typically kept in the hospital overnight and can go home the next day compared to three to five days with open heart surgery. And, although they have a lifting limit for the first week, they can get back to their daily lives quickly afterward, rather than with weeks of recovery and downtime after open heart surgery.”
Because the patients who undergo this procedure are usually older and sicker than patients who can tolerate open heart surgery, the goal is not necessarily to extend longevity. Instead, the goal is to improve people’s symptoms to restore mobility and increase quality of life.
“The MitraClip® procedure can reduce the leakiness of a severely leaky mitral valve, restoring functionality and improving symptomatic impairment,” Fatigante says. “It can help reduce swelling and shortness of breath, which in turn helps the person’s mobility. Keeping the person mobile and able to live day to day is key to moving toward healthier heart habits and preventing further symptoms.”
For more information about the TEER with MitraClip® procedure or heart valve disease, visit the UPMC Center for Heart Valve Disease website.
MitraClip® is a trademark of Abbott.
Editor's Note: This article was originally published on , and was last reviewed on .
The UPMC Heart and Vascular Institute has long been a leader in cardiovascular care, with a rich history in clinical research and innovation. As one of the first heart transplant centers in the country and as the developer of one of the first heart-assist devices, UPMC has contributed to advancing the field of cardiovascular medicine. We strive to provide the most advanced, cutting-edge care for our patients, treating both common and complex conditions. We also offer services that seek to improve the health of our communities, including heart screenings, free clinics, and heart health education. Find an expert near you.