Leaky Heart Valve Treatment: The MitraClip Can Fix It (podcast)

Device helps repair leaky mitral valve without open heart surgery

Dr. Matthew Price, Scripps Clinic Interventional Cardiologist featured in San Diego Health podcast discussing MitralClip

Dr. Matthew Price, Interventional Cardiologist, Scripps Clinic 

Device helps repair leaky mitral valve without open heart surgery

The heart has four valves that make sure blood flows forward and not backward. The mitral valve controls the flow on the left side of the heart. But what happens when this crucial valve doesn’t work properly and causes a backflow or leak?

A leaky mitral valve can be caused by age-related degeneration. The leak allows blood to travel back toward the lungs instead of forward to the brain and muscles. A severe leak can lead to a slew of symptoms ranging from fatigue and shortness of breath to an enlarged heart and eventually congestive heart failure.

Previously, the only recourse for a leaky mitral valve as the condition is known was open-heart surgery. But that wasn’t an option for some patients who were too ill or too frail. Enter the MitraClip, a device that can fix the leak without open-heart surgery. The MitraClip is inserted via catheter and patients can usually go home the next day.

In this episode of San Diego Health, host Susan Taylor and guest Matthew Price, MD, an interventional cardiologist at Scripps Clinic, discuss the MitraClip, what the procedure entails and what the recovery process looks like. Dr. Price has implanted more MitraClips than any other doctor in San Diego and was involved the clinical trials that led to FDA approval of the device.

Listen to the episode on how the MitraClip procedure fixes leaky heart valves

Listen to the episode on how the MitraClip procedure fixes leaky heart valves

Podcast highlights

How does the mitral valve work? (0:41)

The mitral valve is an important valve. It’s the valve that separates the left atrium, which fills with blood from the lungs, and the left ventricle, which is the major pumping chamber of the heart that pushes blood out to the aorta. That valve, which is made up of two leaflets, opens when the heart relaxes and closes when the heart squeezes.

If you have a leaky mitral valve, when your heart squeezes, instead of blood going forward to your brain and your muscles, the blood goes backwards toward the lungs. If you have a severe leak, you can get short of breath, your heart can enlarge and get weak, you could feel tired, gain weight and have problems breathing while doing just even very simple tasks.

What causes a mitral valve to leak? (1:35)

Unfortunately, we get degeneration in the leaflets of a mitral valve as we get older. They become floppier. There are these little cords that tether the leaflet down, much like the tethers of the cords of a parachute, that can actually snap and cause the leaflets of the mitral valve to flutter and not hold when the heart squeezes.

What is the MitraClip? (2:37)

The MitraClip is a really neat thing. If part of the valve is flopping backwards and not sealing with the other leaflet, we just grab the two leaflets and pin them together right where the leak occurs. Instead of going from a single orifice of a valve opening and closing, you go to a double orifice valve. This way, the part that’s leaking will connect to the other leaflet and seal it.

How is a MitraClip procedure done? (3:36)

The MitraClip is a fairly complex device. It looks like a clothespin more than a clip. What’s really neat is that this clip has two arms that open and close. One of the arms grabs what’s called the anterior leaflet and the other arm grabs the posterior leaflet.

What I do is advance this clip through the heart and underneath the leaflets of the mitral valve. Then I retract the arms just a little bit to make a V and pull back on the clip until the two leaflets rest very nicely in those arms. When I see, using a special echocardiogram or ultrasound, that I’ve got both of those leaflets, I drop the grippers. Once I’ve grabbed the leaflets, I’m retract the arms and grab them.

I’ve now brought those leaflets together where they are leaking. I do a very comprehensive assessment to make sure it looks fine. If I don’t like it, no big deal, I can just open up the arms and release the leaflets and move my clipper to grab it again.

If I like how it looks, I can release the clip from the cable to which it’s attached and leave it behind.

I can put in as many as one to four clips in a particular patient in order to reduce that leak so the patient feels better. Their heart remodels and gets stronger. The blood pressure in their lungs comes down and they can hopefully regain their quality of life.

What is the recovery time? (7:35)

One of the miracles of modern medicine is if a patient walks into the hospital for this procedure, the patient goes home the next day.

When a patient goes through open-heart surgery, the patient stays a week or longer in the hospital and really doesn’t feel like themselves for at least one month, if not months.

With a MitraClip procedure, patients go home the next day. They have very few limitations. I don’t like patients to lift heavy things for a few days after the procedure just to protect their groin, but otherwise, recovery is very rapid.

Who is a candidate for a MitraClip procedure? (10:43)

When someone is being evaluated for a MitraClip, it’s a fairly comprehensive evaluation. We do a whole host of tests.

We need to make sure that the patient is anatomically eligible for the clips. There are certain situations, certain types of mitral valve problems, that the clip is not a great solution for. That's the exception rather than the rule.

We want to make sure that there aren’t other things going on that are more important than the leaky mitral valve. There are a lot of reasons why people can be short of breath, so we need to confirm that the leak is severe and needs to be fixed.

We have a comprehensive heart team approach. Patients see me, a cardiac surgeon, and often will see a heart failure physician who specializes in heart-related shortness of breath. Together, we come up with a decision: Should we operate on this patient? Should we put in a MitraClip or maybe they don’t need mitral valve therapies at all.

Lightly edited for clarity.

Watch the video on how the MitraClip fixes leaky mitral valves

Watch the San Diego Health video with host Susan Taylor and Dr. Teirstein discussing how the MitraClip helps repair leaky mitral heart valves.

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