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For patients with severe mitral regurgitation, evidence of degenerative mitral valve disease on transesophageal echocardiography (TEE), and for those patients who are at high risk of surgical complications (based on the STS scoring system – see link), the Heart Valve Program at the AMITA Health Heart & Vascular Institute now offers an FDA-approved, minimally invasive procedure for mitral valve repair using the MitraClip® device.
The STS surgical risk score takes into account several patient- and procedure-related factors to estimate the risk of adverse outcomes of cardiac surgery, including death, stroke, prolonged hospital stay, and repeat surgery. Factors considered include the type of cardiac surgery, patient age, sex, health history, and experience and outcomes of previous surgeries.
Patients with mitral valve regurgitation who are referred to the Heart Valve Program at the AMITA Health Heart & Vascular Institute undergo a comprehensive evaluation to confirm the diagnosis and assess surgical risk. A cardiologist specializing in echocardiography and experienced in the MitraClip® procedure will perform a TEE to evaluate mitral valve anatomy, determine the severity and cause of the disease (and distinguish between a primary problem of the valve versus a problem of the heart muscle), and identify what part of the valve is involved. Potential candidates for the MitraClip® procedure are then reviewed by the entire multidisciplinary Heart Valve Program team—a mix of cardiologists and cardiac surgeons who work across disciplinary boundaries to discuss each patient’s needs and determine the most appropriate treatment approach. Primary care and referring physicians are kept informed of the patient’s workup and treatment.
The minimally invasive MitraClip® procedure is performed in the cardiac catheterization lab as an outpatient procedure with an overnight hospital stay. A catheter is inserted through the femoral vein (via a 1/2-inch incision in the groin). The catheter is directed by TEE and fluoroscopy from the right side to the left side of the heart and finally to the mitral valve. Threaded through the catheter, the MitraClip® (a 1-cm long titanium clip) is attached to the affected areas of the mitral valve leaflets. By bringing together the leaflets, blood is kept from flowing back into the left atrium and lungs, thereby reducing lung congestion.
The positioning of the clip and the amount of backflow are monitored during the procedure, and decisions to reposition the clip or place additional clips are made on the spot to avoid the need for a second procedure. Once the MitraClip® has been placed, the patient recovers overnight. The next day, a repeat transthoracic echo (TTE) is performed to verify clip placement and reduction in mitral valve regurgitation and the patient is discharged.
For most patients, placement of the MitraClip® is sufficient to reduce the amount of regurgitation through the mitral valve to a level that results marked improvement in patient symptoms and reduces hospital readmissions from heart failure.
At the AMITA Health Heart & Vascular Institute, all members of the MitraClip® team have undergone special training on the procedure. Dr. Barrow has extensive experience with MitraClip®, having performed close to 100 procedures during the one year of advanced structural training he underwent after his standard interventional cardiology fellowship. Dr. Shivaraju has done additional training in structural heart disease interventions at the German Heart Center in Munich and has extensive experience in performing these minimally invasive procedures.
All patients treated with the outpatient MitraClip® procedure at the AMITA Health Heart & Vascular Institute thus far have shown significant reductions in leakage and a significant improvement in symptoms.
Once a patient is referred to the Heart Valve Program for evaluation of mitral valve regurgitation, clinical coordinators Lynn Hickman and Lindsay Carroll keep in touch with the primary referring physician, the patient, and the patient’s family before and after any procedure. They coordinate scheduling, greet patients when they come to the clinic, follow-up with patients and family members the day after the procedure and make post-op follow-up calls. Patients usually follow-up with the Heart Valve Program care team a week after the MitraClip® procedure and the primary referring physician is updated on outcomes and symptoms. Most patients then return to their primary referring physician and follow-up with the Heart Valve Program care team at approximately one month and one year.
After her 90-year-old mother underwent the MitraClip® procedure, the patient’s daughter reported that “mom is all over the place now, doing better than she was years ago. It’s amazing that her recovery and the effect were so quick.”
In addition to MitraClip®, the AMITA Health Heart & Vascular Institute physicians perform various highly complex surgical and minimally invasive procedures, such as aortic abdominal aneurism repair, transcatheter aortic valve replacement (TAVR), and Watchman device placement (for patients with atrial fibrillation).
The highly specialized and extensively trained cardiologists and cardiac surgeons at the AMITA Health Heart & Vascular Institute, together with the entire team of nurses, technicians, and support staff, collaborate closely to deliver university-level care in the heart of the community. The AMITA Health Valve Clinic serves as a referral center for valvular heart disease for hospitals and physicians from AMITA Health hospitals and the surrounding communities.
Andrei Pop, MD, FACC, FSCAI, RPVI
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Firas Barrow, MD
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Anupama Shivaraju, MD
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