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"MitraClip Procedure Overview"

"MitraClip Procedure Overview"

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 Authored by Dr. Reza Lankarani, General Surgeon MitraClip™ is a minimally invasive transcatheter edge-to-edge repair (TEER) device designed to treat mitral regurgitation (MR), a condition where the mitral valve fails to close properly, causing blood to leak backward into the heart. Inspired by the Alfieri surgical technique, which sutures the valve leaflets to create a double orifice, the MitraClip uses a small metal clip to grasp and coapt the leaflets, reducing regurgitation . It is the first FDA-approved transcatheter mitral valve repair therapy and has been used in over 200,000 patients globally.------------------------------------------------------------Indications: - Primary (Degenerative) MR: For patients at prohibitive surgical risk due to age, frailty, or comorbidities (e.g., severe COPD, renal failure) . - Secondary (Functional) MR: For patients with heart failure and persistent symptoms despite optimal guideline-directed medical therapy (GDMT), LVEF 20–50%, and LVESD ≤70 mm . Contraindications:- Active endocarditis, rheumatic mitral disease, or blood clots in the heart/inferior vena cava . - Allergies to device materials (nickel, titanium, polyester) or inability to tolerate anticoagulation .------------------------------------------------------------Procedure Overview: The MitraClip procedure is performed under general anesthesia with fluoroscopic and transesophageal echocardiography (TEE) guidance.Key steps include: 1. Transseptal Puncture: Accessing the left atrium via the femoral vein, with the puncture site optimized for clip alignment . 2. Clip Delivery: A steerable catheter guides the clip to the mitral valve. The clip is opened, advanced into the left ventricle, and used to grasp the leaflets . 3. Assessment: Real-time TEE evaluates regurgitation reduction and mitral stenosis risk (target gradient ≤5 mmHg). Additional clips may be placed if needed . 4. Deployment: The clip is released, and the catheter is withdrawn. Most procedures take 1–3 hours, with a hospital stay of 1–3 days .------------------------------------------------------------Clinical Outcomes: - Survival and Hospitalization: - In the COAPT trial, MitraClip reduced heart failure hospitalizations by 47–51% and mortality risk by 33% over 2–3 years . - Patients with secondary MR showed improved survival compared to medical therapy alone . - Quality of Life: - 2.5× higher likelihood of significant improvement in Kansas City Cardiomyopathy Questionnaire (KCCQ) scores . - Symptoms like shortness of breath and fatigue improved in 95% of cases . - Durability: - EVEREST II trial demonstrated sustained MR reduction and reverse LV remodeling at 5 years . Risks and Complications:- Procedural Risks: - Vascular complications (3–13% requiring transfusion), atrial septal defects, or pericardial effusion . - Single-leaflet detachment (1–3%) or device embolization (rare) . - Post-Procedural Risks: - Mitral stenosis (if gradients exceed 5 mmHg) or residual MR . - Overall 30-day complication rate: 15–19% Device Innovations:The MitraClip G4 System (4th generation) offers: - Four Clip Sizes: NT (9 mm), NTW (12 mm), XT (15 mm), and XTW (18 mm) for tailored repairs . - Controlled Gripper Actuation: Allows independent leaflet grasping for complex anatomies . - Enhanced Imaging Integration: Improved delivery system stability for precise placement . ------------------------------------------------------------Guidelines and Recommendations:- 2022 AHA/ACC/HFSA Guidelines: Class 2a recommendation for TEER in secondary MR patients with LVEF 20–50% and persistent symptoms despite GDMT . - Patient Selection: Requires a multidisciplinary heart team to evaluate surgical risk, anatomy, and comorbidities . Post-Procedure Care:- Medications: Aspirin (lifelong) and clopidogrel (30 days) for antiplatelet therapy; anticoagulants for atrial fibrillation . - Activity Restrictions: Avoid strenuous activity for 7 days; follow-up echocardiograms at 30 days and annually . ------------------------------------------------------------Conclusion:MitraClip™ represents a paradigm shift in treating MR for high-risk patients, offering survival benefits, symptom relief, and faster recovery compared to surgery. Ongoing innovations, such as the G4 system, continue to expand its applicability. However, careful patient selection and procedural expertise remain critical for success . Reza Lankarani M.D#mitraclip#mitraclip procedure#mitraclip therapy#mitral valve repair#minimally invasive heart procedure#mitral regurgitation#heart valve treatment#interventional cardiology#cardiac catheterization#mitraclip benefits#mitraclip risks#mitraclip recovery#mitraclip screening#mitraclip procedure steps#heart health#valve repair surgery #Surgical Pioneering #Reza Lankarani Get full access to Reza Lankarani at lankarani.substack.com/subscribe

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