The heart clip for mitral valve repair is a significant advance in treating mitral regurgitation (MR) without requiring traditional open-heart surgery. This small medical device is implanted using a minimally invasive approach to correct the disorder where the heart’s mitral valve does not close completely. The procedure offers a less invasive alternative for patients whose symptoms persist despite medical treatment and whose surgical risk is high. By addressing the malfunctioning valve, the heart clip restores more efficient blood flow, reducing strain on the heart muscle and improving the patient’s quality of life.
The Heart Clip: Structure and Therapeutic Goal
The heart clip is a small, durable metal device, approximately the size of a dime, covered with polyester fabric to encourage tissue growth. It is designed to mimic the Alfieri stitch surgical technique by connecting the valve leaflets. Devices such as the MitraClip or PASCAL system allow this repair to be performed through a catheter rather than a large incision.
The primary therapeutic goal is to treat MR, where the mitral valve’s two leaflets fail to seal properly, causing blood to leak backward into the left atrium. This backward flow forces the heart to work harder, leading to symptoms like fatigue and shortness of breath. The clip functions on the “edge-to-edge” repair principle, grasping the middle segments of the anterior and posterior mitral valve leaflets.
Once deployed, the clip holds the leaflets together, reducing the gap through which blood leaks. This physical connection creates a “double-orifice” in the valve, allowing blood to flow forward while minimizing backflow. The reduction in regurgitation immediately decreases volume overload in the left atrium, lessening the workload on the left ventricle.
The Minimally Invasive Implantation Process
The heart clip is implanted during a procedure called transcatheter edge-to-edge repair (TEER), which eliminates the need to open the chest cavity. The process begins with the patient under general anesthesia in a cardiac catheterization laboratory. An interventional cardiologist makes a small incision in the groin area to access the femoral vein.
A thin, flexible catheter is then inserted into the vein and guided through the body’s vascular system up toward the heart. The catheter travels through the right atrium until it reaches the interatrial septum, the wall separating the upper heart chambers. A specialized needle is used to create a small puncture, known as a transseptal puncture, allowing the delivery system to enter the left atrium.
Once in the left atrium, the clip delivery system is manipulated to position the clip directly above the mitral valve. The entire procedure is performed under continuous imaging guidance, primarily using transesophageal echocardiography (TEE). This visual feedback is necessary for aligning the clip perpendicular to the valve leaflets and ensuring an effective grasp.
The clip is opened, advanced into the left ventricle, and then retracted to capture the edges of both leaflets. The cardiologist confirms the secure capture of the leaflets and assesses the immediate reduction in mitral regurgitation using the TEE before the clip is released. If the reduction in leakage is insufficient, the clip can be retrieved and repositioned, or a second clip can be implanted to optimize the result.
Patient Selection and Eligibility Criteria
The decision to use a heart clip involves a rigorous assessment by a multidisciplinary heart team, including interventional cardiologists and cardiac surgeons. This team evaluates the patient’s overall health, the severity of their mitral regurgitation, and the specific anatomy of their mitral valve. The procedure is most frequently recommended for patients who have severe, symptomatic mitral regurgitation but are considered to be at high or prohibitive risk for traditional open-heart surgery.
For patients with secondary, or functional, mitral regurgitation—where the leakage is caused by the heart muscle enlarging—specific criteria include a left ventricular ejection fraction between 20% and 50%. The patient must also have persistent symptoms and severe MR despite receiving optimal medical therapy. Anatomical suitability is paramount for successful clip placement; the valve leaflets must have sufficient tissue available to be grasped.
Ideal candidates have a coaptation length (leaflet overlap) of more than two millimeters and a coaptation depth of less than eleven millimeters. The size of the regurgitant gap and the overall structure of the valve are factors that determine if the clip can effectively reduce the leak without creating a new obstruction to blood flow. If the valve structure is too complex or damaged, the procedure may not be feasible.
Post-Procedure Care and Expected Outcomes
Following the minimally invasive TEER procedure, patients experience a rapid recovery compared to traditional surgery. Most individuals spend only one to three days in the hospital for monitoring. The immediate post-procedure care focuses on managing the small access site in the groin and ensuring the patient is stable.
Patients are often placed on a dual antiplatelet regimen, such as aspirin and clopidogrel, for a short period to prevent blood clots from forming on the newly placed clip. Long-term care involves regular follow-up appointments with the cardiologist, including transthoracic echocardiograms, to monitor the clip’s function and the heart’s remodeling. These imaging checks are scheduled at intervals like six months and then annually to assess for residual or recurrent mitral regurgitation and to measure the transmitral gradient.
The expected outcomes are positive, with rapid improvement in symptoms such as shortness of breath and fatigue, often noticeable within days or weeks. Clinical trials have demonstrated that successful clipping improves the patient’s functional capacity and quality of life. While the risk of complications is low, the heart team monitors for potential issues like bleeding at the access site, clip dislodgement, or incomplete reduction of the regurgitation.