MitraClip Explained: Transcatheter Edge-to-Edge Mitral Repair (TEER)
Key takeaways
- MitraClip is a form of transcatheter edge-to-edge repair (TEER): a keyhole procedure that clips the two leaflets of a leaking mitral valve together to reduce the leak, without opening the chest.
- It is delivered by a catheter threaded up through a vein in the groin, so there is no sternotomy and the recovery is measured in days rather than weeks.
- It is offered mainly to patients whose mitral regurgitation is severe and symptomatic but whose surgical risk is high, where an open operation would be hazardous.
- In heart-failure patients with secondary mitral regurgitation, the COAPT trial showed TEER cut hospitalisations for heart failure over two years to 35.8% versus 67.9% with medication alone.
- It is a repair, not a replacement, and whether it suits you is a decision for a heart team experienced in structural heart procedures.
Published
MitraClip is a form of transcatheter edge-to-edge repair (TEER): a keyhole procedure that clips the two leaflets of a leaking mitral valve together to reduce the leak, delivered by a catheter through a vein in the groin, without ever opening the chest 1. I did not have this procedure myself; my problem was the aortic valve. But I met a man on the ward waiting for a MitraClip, and once I understood it I realised it belongs to the same quiet revolution that gave me my own new valve without a saw. Here is how it works.
What MitraClip and TEER actually are
MitraClip is the best known device for transcatheter edge-to-edge repair, a technique that treats a leaking mitral valve from the inside 2. The mitral valve sits between the two left chambers of the heart and has two leaflets that should meet cleanly to stop blood washing backwards. When they fail to close, blood leaks back, a condition called mitral regurgitation. TEER places a small clip that joins the middle of the two leaflets, leaving a double opening on either side, which lets the valve seal far better while still letting blood through. The whole thing is done without a chest incision and without stopping the heart.
How the clip is placed
The clip reaches the valve by catheter, threaded up through a vein in the groin and across into the left side of the heart, guided by X-ray and detailed ultrasound imaging 1. The cardiologist positions the clip on the leaking part of the valve, closes it onto both leaflets, and checks the leak has fallen before releasing it. If one clip is not enough, a second can sometimes be added. Because there is no sternotomy and no heart-lung machine, most people stay in hospital only a day or two, which is why it can be offered to patients who could never withstand open surgery.
The man I met described it almost with disbelief: no chest wound, home within days. It was exactly the reaction I had had to my own aortic procedure, and it is worth pausing on how new all of this still is.
Who MitraClip is for
MitraClip is offered mainly to patients with severe, symptomatic mitral regurgitation who are at high risk from conventional surgery, whether from a weak heart muscle, advanced age, or other illnesses 2. The decision is made by a heart team experienced in structural heart disease, and it hinges on the anatomy of the valve seen on imaging, because not every leaking valve can be clipped. It is deliberately not the first choice for younger, lower-risk patients, in whom a surgical repair can often achieve a more complete result. Understanding the underlying leak first helps, and I have set that out in mitral valve regurgitation.
What the evidence shows
The strongest evidence comes from the COAPT trial, which studied patients with heart failure and secondary mitral regurgitation. Over two years, TEER reduced hospitalisations for heart failure to 35.8% of patients, compared with 67.9% in those treated with medication alone, and it also lowered deaths 3. That is a substantial difference for a group who were, by definition, too unwell for easy options. National bodies including NICE have reviewed the technique and set out where it fits in careful patient selection 4. As always with a young field, the results depend heavily on choosing the right patients and on the experience of the team.
Repair, not replacement
It is worth being clear that MitraClip repairs the valve rather than replacing it, and it reduces the leak rather than abolishing it entirely 1. Some patients are left with mild residual regurgitation, and the clip becomes a permanent implant that tissue grows over in time. That places it firmly on the repair side of a broader story, the shift from open operations towards catheter procedures, which I explore in transcatheter versus surgical valve. For the right patient, trading a slightly less complete repair for avoiding major surgery is a trade well worth making.
General information, not medical advice. MitraClip suits only certain patients and valve anatomies, and the risks and benefits differ for each person; please discuss whether it is appropriate for you with a heart team experienced in structural heart procedures.
References
- MitraClip, Cleveland Clinic. ↩
- 2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease, American College of Cardiology / American Heart Association. ↩
- Transcatheter Mitral-Valve Repair in Patients with Heart Failure (COAPT), New England Journal of Medicine. ↩
- Percutaneous mitral valve leaflet repair for primary degenerative mitral regurgitation, National Institute for Health and Care Excellence (NICE). ↩
Common questions
What is a MitraClip?
A MitraClip is a small implanted clip used to treat a leaking mitral valve. It is placed by transcatheter edge-to-edge repair, or TEER, in which a catheter is threaded up through a vein in the groin to the heart and the clip is used to join the middle of the two mitral leaflets. This narrows the gap the blood leaks through, so the valve seals better, all without opening the chest.
Who is a candidate for MitraClip?
It is aimed mainly at people with severe, symptomatic mitral regurgitation who are at high risk from open-heart surgery, whether because of age, a weak heart muscle, or other illnesses. A heart team assesses the anatomy of the valve on detailed imaging, because not every leaking valve is suitable for a clip. It is a shared decision, weighing the likely benefit against the risks.
How is MitraClip different from valve surgery?
Surgery repairs or replaces the mitral valve through an incision in the chest, usually with the heart stopped and a heart-lung machine running. MitraClip repairs the valve from the inside using a catheter, with no chest incision and no heart-lung machine, so recovery is far quicker. The trade-off is that surgery can achieve a more complete repair in suitable patients, which is why lower-risk patients are often still offered an operation.
Is MitraClip a permanent fix?
The clip itself is a permanent implant, and tissue grows over it in time. It reduces the leak rather than abolishing it entirely, and some patients still have mild residual regurgitation afterwards. A minority need more than one clip, and a few need further treatment later. Your cardiologist follows the valve over time with echocardiograms to check how well the repair is holding.
What are the risks of a MitraClip procedure?
Because it avoids open surgery, it is generally well tolerated even in frail patients, but it is not risk-free. Possible complications include bleeding at the groin access site, the clip not reducing the leak enough, partial detachment of the clip, or narrowing of the valve. The heart team weighs these against the risk of leaving severe regurgitation untreated, which in symptomatic patients is itself dangerous.
How long does recovery from MitraClip take?
Most people stay in hospital only a short time, often a day or two, because there is no chest wound to heal. Many feel their breathlessness ease within weeks as the heart adjusts to the reduced leak. This quick recovery is much of the appeal for patients who could not withstand the long convalescence of open mitral surgery.
Written by Diane Farrow. Medically reviewed by Dr. Helena Voss, MD, FESC.
Our guides are written from personal experience and reviewed by a qualified clinician for accuracy. Read our editorial policy.
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