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.
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.
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.
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.
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.
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.