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OVERVIEW

Transcatheter edge-to-edge repair utilizing the MitraClip system is an interventional cardiac procedure that restores functional mechanical competence to a leaking mitral valve. The primary treatment objective is to eliminate or significantly decrease severe mitral regurgitation (MR)—a condition where blood flows backward from the left ventricle into the left atrium during ventricular contraction. By mechanically grasping and joining the central portions of the mitral valve leaflets, the device replicates the surgical Alfieri edge-to-edge repair technique without requiring open-heart surgery, sternotomy, or cardiopulmonary bypass. The procedure falls within the medical domain of interventional cardiology and structural heart disease management.

PROCEDURE

Transcatheter edge-to-edge repair is performed under general anesthesia with continuous transesophageal echocardiography (TEE) and fluoroscopy guidance. Access is established through the right femoral vein using a large-bore introductory sheath. A catheter is advanced into the right atrium, and a precise transseptal puncture is performed under TEE to cross into the left atrium. A steerable guide catheter (SGC) is then positioned within the left atrium. The Clip Delivery System (CDS) carrying the folded clip is advanced through the guide catheter and positioned directly above the mitral valve origin of regurgitation. The device is oriented perpendicular to the line of coaptation and advanced into the left ventricle below the leaflets. Upon pullback, the clip arms are opened to catch both the anterior and posterior leaflets simultaneously. Leaflet grasping is confirmed on echocardiography, ensuring adequate tissue bridge, reduction of mitral regurgitation to Grade 2+ or lower, and maintenance of an acceptable mean transvalvular gradient (typically under 5 mmHg). Once stability and efficacy are confirmed, the clip is deployed and detached from the delivery system. If residual significant regurgitation persists and anatomical space permits, a second or third clip may be deployed using the same protocol. Finally, the delivery system is withdrawn, and the femoral vein puncture is closed using percutaneous suture-based closure devices or manual compression.

BENEFITS

Evidence from landmark clinical trials demonstrates that transcatheter edge-to-edge repair significantly improves functional status, quality of life, and survival in appropriately selected patients. In secondary mitral regurgitation, trial data show a significant reduction in annual heart failure hospitalizations and lower 2-year all-cause mortality compared to medical therapy alone. Clinical outcomes include reduced left ventricular volume (favorable cardiac remodeling), improved 6-minute walk distance, and a shift in New York Heart Association (NYHA) functional class from symptomatic Class III/IV to Class I/II in the majority of treated individuals. Furthermore, as a percutaneous approach, it eliminates the morbidity associated with median sternotomy and cardiopulmonary bypass, resulting in shorter hospital stays and faster physical recovery.

RECOVERY

Immediate recovery involves strict bed rest for 4 to 6 hours after vascular sheath removal to ensure hemostasis at the femoral access site. Most patients are ambulatory on post-procedure day one and are discharged within 24 to 72 hours. Initial physical restrictions include avoiding heavy lifting (greater than 10 pounds) and strenuous exertion for 1 to 2 weeks to allow the femoral vein access site to heal. Dual or single antiplatelet therapy is typically prescribed for 1 to 6 months based on underlying clinical indications. Patients experience gradual functional improvement over 30 to 90 days as the heart adapts to reduced regurgitant volume. Clinical follow-up includes an echocardiogram at 30 days to evaluate clip stability, residual regurgitation, and mean transvalvular gradient.

WHAT WE TREAT

This procedure is designed to treat moderate-to-severe (3+) or severe (4+) mitral regurgitation. This encompasses two major clinical phenotypes: primary (degenerative) mitral regurgitation, where structural defects of the valve apparatus (such as leaflet prolapse, flail leaflet, or chordal rupture) cause improper closure; and secondary (functional) mitral regurgitation, where the valve leaflets are structurally normal but fail to coapt properly due to left ventricular dilation, ischemic cardiomyopathy, or non-ischemic dilated cardiomyopathy. The treatment is specifically tailored for individuals who remain severely symptomatic despite full guideline-directed medical therapy or who face excessive surgical risk for conventional open repair or replacement.

PREPARATION

Pre-procedural preparation requires a detailed diagnostic evaluation. Patients undergo a baseline transthoracic echocardiogram (TTE) followed by a specialized transesophageal echocardiogram (TEE) to measure precise anatomical parameters, including leaflet length, coaptation depth, coaptation length, and flail gap. A multi-slice computed tomography (CT) scan of the pelvis and abdomen may be obtained to map femoral access pathways if peripheral artery disease or anatomical variants are suspected. Routine blood work includes complete blood count, renal panel, coagulation parameters, and cardiac biomarkers. Guideline-directed medical therapy for heart failure is optimized for at least several weeks prior to consideration of intervention. Antiplatelet or anticoagulant regimens are managed according to cardiac electrophysiology and interventional guidelines, with oral anticoagulants typically held briefly prior to the procedure. Patients must fast for 8 hours before general anesthesia.

RISKS

While percutaneous transcatheter repair carries a lower risk profile than open-heart surgery, procedural and post-procedural complications can occur. Minor or common side effects include localized hematoma or bruising at the femoral access site, transient atrial arrhythmias (such as atrial fibrillation), and mild post-procedural groin pain. Less common complications include vascular access site bleeding requiring transfusion, pseudoaneurysm formation, clip detachment or single leaflet device attachment (SLDA) occurring in 1% to 3% of cases, and moderate elevation in transmitral mean pressure gradient. Severe but rare complications (occurring in under 1% to 2% of patients) include cardiac perforation leading to pericardial tamponade, ischemic stroke or systemic embolism, severe acute mitral stenosis, infectious endocarditis, emergency conversion to open surgical repair, and procedure-related mortality.

JOURNEY

The clinical trajectory for transcatheter edge-to-edge repair begins with an extensive pre-procedural assessment by a multidisciplinary Heart Team, including transesophageal echocardiography to confirm anatomical suitability and risk stratification. On the day of the intervention, the procedure is performed under general anesthesia in a catheterization laboratory using continuous echocardiographic and fluoroscopic guidance. Access is gained via the femoral vein, followed by a controlled transseptal puncture to reach the left atrium. The clip is navigated, aligned, and deployed across the leaking valve leaflets. Following clip placement, the patient spends 12 to 24 hours in a monitored cardiac unit before transitioning to a general ward. Most individuals are discharged within 1 to 3 days, resuming mild activities within a week and undergoing serial echocardiographic follow-up at 30 days, 6 months, and annually thereafter.

Hospitals Offering this treatment

India offers premium medical procedures at affordable prices. Discover our most popular treatments, delivered by the country's finest doctors.

Hisar Intercontinental Hospital

Hisar Intercontinental Hospital

Saray Mah. Siteyolu Cad. No:7, Umraniye, 34768, Istanbul, Turkey

Medical Park Group, Istanbul

Medical Park Group, Istanbul

Fahrettin Kerim Gokay Cad. Tıbbiye Cd., Kadikoy, Istanbul, Turkey

Emsey Hospital, Pendik, Istanbul

Emsey Hospital, Pendik, Istanbul

Çamlık, Selçuklu Cd. No:22, 34912 Pendik/İstanbul, Türkiye

LIV Hospital, Istanbul

LIV Hospital, Istanbul

American Hospital, Istanbul

American Hospital, Istanbul

Guzelbahce Sk. No:20, 34365, Nisantasi, Istanbul, Turkey

Memorial Hospitals Group

Memorial Hospitals Group

Burhaniye, Nagehan Sokağı No:4/A D:1, 34676 Üsküdar/İstanbul, Türkiye

Florence Nightingale Hospital Istanbul

Florence Nightingale Hospital Istanbul

Abide-i Hürriyet Cd No:166, 34381 Sisli, Istanbul

Medicana International Hospital, Istanbul

Medicana International Hospital, Istanbul

Halit Ziya Turkkani Mah. Medikal Park Cd. No:1, Beylikdüzü, İstanbul

Okan University Hospital Istanbul

Okan University Hospital Istanbul

Icmeler Mah. Aydınlıyolu Cd. No:2, 34947 Icmeler-Tuzla, Istanbul

Kolan International Hospital, Istanbul

Kolan International Hospital, Istanbul

Kaptanpasa Mah. Okmeydan Kavsagi, Darulaceze Cd. No:14, 34384 Sisli, Istanbul

Al Zahra Hospital, Dubai

Al Zahra Hospital, Dubai

Sheikh Zayed Road, Al Barsha 1, Dubai, UAE

Burjeel Medical City, Abu Dhabi

Burjeel Medical City, Abu Dhabi

28th Street, Mohammed Bin Zayed City, Abu Dhabi, UAE

Burjeel Hospital, Dubai

Burjeel Hospital, Dubai

Dubai, UAE (part of Burjeel Holdings network)

King's College Hospital, Dubai

King's College Hospital, Dubai

Dubai Hills, Mohammed Bin Rashid City, Dubai, UAE

Neuro Spinal Hospital (NSH), Dubai

Neuro Spinal Hospital (NSH), Dubai

Dubai Science Park, Umm Suqeim St, Al Barsha South, Dubai, UAE

HMS Al Garhoud Hospital, Dubai

HMS Al Garhoud Hospital, Dubai

Al Garhoud Street, Al Garhoud, Dubai, UAE

Canadian Specialist Hospital, Dubai

Canadian Specialist Hospital, Dubai

Abu Hail Street 269/1, Canadian Specialist Hospital Building, Hor Al Anz East, Deira, Dubai, UAE

NMC Royal Women's Hospital, Abu Dhabi

NMC Royal Women's Hospital, Abu Dhabi

Tower B, Mohammed bin Zayed Stadium, Al Jazira Club, Opposite Dusit Thani, Muroor Road, Abu Dhabi, UAE

NMC Specialty Hospital, Al Nahda, Dubai

NMC Specialty Hospital, Al Nahda, Dubai

7A St, Al Qusais, Al Nahda 2, next to Bait Al Khair Building, Dubai

Bangkok Hospital, Thailand

Bangkok Hospital, Thailand

2 Soi Soonvijai 7, New Petchburi Road, Huay Khwang, Bangkok 10310, Thailand

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