MitraClip Procedure

WHAT IS MITRAL VALVE REGURGITATION?

Mitral Regurgitation (MR) is a common valve abnormality affecting millions of people worldwide. MR is a condition in which heart‘s mitral valve does not close properly, allowing blood to flow backwards into the left atrium.

As a result, blood cannot move through the heart or to the rest of the body as efficiently as it should.
This can lead to symptoms such as fatigue, shortness of breath, coughing (especially when lying down), dizziness, irregular heart beat and worsening heart failure. In those with severe MR these symptoms will eventually impact quality of life and make normal daily activities difficult.

WHY IS A MITRACLIP NECESSARY?

The goal of the MitraClip is to decrease the mitral regurgitation aiming to improve symptoms and overall quality of life. Medications may be prescribed to help reduce the symptoms but they cannot fix the valve itself.

The most common option for treating severe mitral regurgitation is to perform open heart surgery, to either replace the valve or repair the existing mitral valve.

However, if the patient is very ill or has other medical problems, open heart surgery is not an option. In these situations, the patient may be referred for a MitraClip procedure. The eligibility for this procedure will be decided by a specialized cardiology team.

WHO IS A GOOD CANDIDATE FOR A MITRACLIP?

A MitraClip procedure is not without risks, but it provides a beneficial treatment option to people who cannot have surgery.

A MitraClip can be used:

• If the patient has no blood clots in his/her heart
• If the patient does not need surgery to fix other heart problems
• If the patient has no bleeding disorder, untreated ulcer, and is able to take aspirin and clopidogrel
• If the patient has no active infection anywhere in the body (the device cannot be implanted if there is an active infection)
• If the mitral valve does not have a large amount of calcium deposits (calcified) or is not stenotic (narrowed)
• If the patient’s anatomy is suitable for implantation of the device

THE MITRACLIP PROCEDURE

The MitraClip procedure is performed in the hybrid operation room, under general anesthetic using a minimally invasive technique. This procedure is done by use of a catheter (a flexible tube) which is inserted through a large vein in the groin and guided to the heart using x-ray images.

Once the catheter has reached the heart, a tiny puncture is created through the atrial septum. This allows the catheter to be guided to the left side of the heart, where the mitral valve is located.

Once the catheter is in the correct position the physician will assess the mitral valve using transesophageal echocardiography (TEE) and x-ray images. Through the catheter, the Mitraclip is advanced and attached to the mitral valve leaflets.

Once the clip is firmly in place the MR is reassessed. In some instances the desired reduction in MR may not be achieved with one Mitraclip and a second may need to be placed.

TESTS REQUIRED PRIOR TO MITRACLIP PROCEDURE

• Blood tests and ECG
• Transesophageal Echo
• Dental assessment
• Left and right cardiac catherization
• Pre anesthetic testing (PAT)

PRE-PROCEDURE INFORMATION

• A member of our team will call you the last working day prior to the procedure to confirm the procedure and answer any questions you may have.
• Your expected arrival time will be confirmed during this phone call. It is important to arrive on time for your procedure.
• Please bring all your medication with you.

DIABETIC PATIENTS

As you are required to fast no oral diabetic medication should be taken on the day of the procedure. If you take insulin your daily dose may need to be adjusted. A member of our team will give you further instructions.

POST-PROCEDURE INFORMATION

• The average hospital stay for this procedure is 2-3 days, but this may vary.
• After the procedure the patient is required to take aspirin for life and clopidogrel (Plavix ) for three months.
• Antibiotics will need to be taken before certain medical procedures (for example, dental cleaning/dental surgical procedures as well as certain surgeries) for up to 6 months post device placement.
• Medications should only be taken as directed by a physician. Never stop taking any medication without speaking with the physician who prescribed it. Alternatively, you can call the Cleveland Clinic Contact Center if you have any concerns regarding your medication.
• A follow-up appointment will be necessary 2-4 weeks after discharge. Please ensure this appointment is scheduled before you leave the hospital.

FURTHER INFORMATION

If you have further questions or need additional information please do not hesitate to call the Contact Center at 800 8 CCAD (800 8 2223) and ask to speak to the Heart & Vascular Institute Clinic Interventional Nurse.