Catheter-based mitral valve reconstruction

When conventional cardiac valve surgery is out of the question

Mitral regurgitation is the most common type of valvular insufficiency affecting millions of people worldwide. Depending on the characteristic of clinical symptoms (dyspnoea, cardiac dysrhythmia, etc.), severity of the valvular insufficiency and type of changes found on the leaky cardiac valve the selected therapy is based on medication or cardiosurgical intervention (mitral valve reconstruction / mitral valve replacement).

In recent years a third treatment option has emerged, viz. the catheter-assisted mitral valve reconstruction using Abbott’s MitraClip® system. This gentle procedure is successfully being used in the Schüchtermann-Klinik since 2010.

The patients we treated with the MitraClip® system are invariably of a type, in which the clinical symptoms had hitherto resisted alleviation indicating that mere medication is not sufficient but for whom the risk of a major heart surgery was assessed to be too high.

The MitraClip® system of Abbott

Gentle cardiac valve reconstruction using advanced catheter technology

The catheter-assisted procedure is performed in the hybrid operating theatre on the beating heart and without using the heart-lung machine. The patients receive general anaesthesia and artificial respiration but it is not necessary to open the patient’s thorax. Monitored by radiologic means and ultrasound (TEE), the guide catheter is inserted through a small cut at the patient’s groin (approx. 8mm diameter) and advanced via the venous system up to the heart, where it is guided through the interatrial septum to reach the faulty mitral valve.

Under continuous 3-dimensional echocardiographic control a clip grasps and fastens together the two leaflets of the mitral valve at the points of maximum leaking. Thus the mitral leaflets are held together allowing the cardiac valve to better close again. If the achieved reduction of the mitral regurgitation is not fully satisfying, a second clip may be placed.

After having ensured the stable position of the clip, it is released from the implanting instrument and the catheter is withdrawn. The surgical intervention takes about 2 hours.

Quick recovery thanks to gentle procedure

Immediately after the intervention the patients are shortly monitored in the intensive care unit and after a few days they can leave hospital. In the first 1 – 2 months following the clip implantation (a healing phase of the clip) the patient should avoid exercise or overexertion.

The results of the latest published studies and congress reports demonstrated a permanent reduction of the mitral regurgitation after a successful MitraClip® implantation. The therapy leads to an improvement of the clinical symptoms and a retrogression of the enlarged cardiac cavity. The findings of the Schüchtermann-Klinik regarding patients treated with the MitraClip® system were positive as well. With the patients treated here it was possible to successfully implant a MitraClip® and achieve a distinct reduction of the previously severe mitral insufficiency.

Reduction of the mitral regurgitation by MitraClip® implantation:
Left: significant insufficiency before implantation
Right: mild insufficiency after implantation

This method will certainly gain significance as a supplement to the established procedures for the treatment of mitral regurgitation.

For information on conventional heart valve surgery, click here.