Transcatheter Mitral Valve Repair

There are currently two treatment options for severe mitral regurgitation.

The first option repairs or replaces the valve by open heart surgery, and the second option repairs the mitral valve using a catheter, avoiding open heart surgery.

While open surgery remains the best treatment for mitral valve regurgitation, some patients are too sick for an operation.

Catheter-based repair provides an option they can tolerate, since it is minimally invasive, does not open the chest and avoids a heart-lung machine, which temporarily takes over for the heart and lungs.

We have a proven track record with transcatheter mitral valve repair, relieving symptoms like shortness of breath and avoiding complications like heart failure.

Our program offers:

• Deep experience: We were the first center in Maryland to offer catheter-based mitral valve repair and continue to perform this procedure successfully.
• Skilled team: Our mitral valve surgeons work with top interventional cardiologists, bringing together two disciplines for the best approach.
• Treatment choices: We offer catheter-based repair as an approved treatment for the main form of mitral valve regurgitation as well as clinical trial options they are not widely available. 

How Transcatheter Mitral Valve Repair Works

Cather-based mitral valve repair is completed in several steps:

1. Our team makes a small incision in the groin, then threads a thin tube (catheter) through a vein toward the heart.
2. The doctors use the catheter to deliver a special metal clip with two arms (the MitraClip) to the mitral valve. They position the clip between the valve’s two flaps (leaflets).
3. The doctors close the clip’s arms, pulling the leaflets together and permanently locking them in place. This creates a tighter seal, preventing blood from flowing backward.

Heart failure specialists help evaluate and care for patients both before and after the procedure. Patients usually stay in the hospital for two to five days, shorter than the stay for an open operation.

Transcatheter Mitral Valve Repair Candidates

We provide catheter-based mitral treatment for two groups of patients too sick for open surgery to repair or replace the valve. We do so either through an already-approved approach or a late-stage clinical trial:

• Approved: The approved approach is for patients who have the degenerative form of mitral regurgitation, characterized by structural defects in the valve. Their valves are severely compromised and they are experiencing problems. They are not eligible for standard surgery because of risk factors like advanced age, a condition such as kidney failure or a previous heart operation.
• Trial: The Cardiovascular Outcomes Assessment of Percutaneous Therapy (COAPT) clinical trial is designed for patients with the functional form of mitral regurgitation, caused by an enlarged heart or heart failure. Patients must have moderate to severe leaking that is causing problems and be ineligible for traditional surgery. Since it is still a clinical trial, patients are randomly (and blindly) divided into two groups for comparison. The test group undergoes mitral valve repair. The control group receives existing treatments: medication, a pacemaker and/or relief for coronary artery disease.