A clipping procedure through the leg to treat a leaking heart valve, a MitraClip can be a reasonable alternative to open heart surgery.
What’s a MitraClip used to treat?
Mitral regurgitation is a condition due to abnormal leaking of the main back-flow valve on the left side of the heart (the mitral valve). This valve normally stops back-flow of blood back into the lungs.
When the leak is significant it may cause excessive stress on the heart leading to the heart failing and abnormal heart rhythm. This can cause symptoms of being short of breath, leg swelling and abnormal heart beat sensations (palpitations).
The traditional way to fix a severely leaking mitral valve is by open heart surgery. However, for some patients their other health problems or the nature of the heart health means that they would not likely make it through or recover from an open-heart procedure. In these situations, treating the leaking valve with a clipping procedure through the leg (MitraClip) can be a reasonable alternative.
After careful assessment and consideration (involving you, your treating doctors, cardiologists and heart surgeons at The Wesley) it may be assessed that a MitraClip be recommended for the management of your mitral valve disease. Where this is the case the procedure usually involves the following:
- General anaesthetic (fully put to sleep) with a breathing machine to support breathing
- An ultrasound probe (transoesophageal echocardiogram probe) is placed down your food pipe to visualise the heart.
- A tube called a sheath is inserted into the vein in the leg.
- A delivery cable carrying the repair device is taken up to the heart through the sheath (tubes described in the point above) and positioned to clip the leaking portion of the mitral valve. Two or three clips may be required (Figure 1).
- This process involves crossing from the right to left side of the heart internally and involves creating a small hole in one of the internal walls (called the atrial septum) in the heart.
Are there any risks with a MitraClip?
The procedure has many potential risks. The information supplied here is for general reference only based on the published data around the procedure from across the world. Risks specific to your condition and overall situation need to be discussed with your treating doctor. It should be understood that even though MitraClip is potentially a less invasive treatment option than open heart surgery, it is still associated with real risks. Potential risks of MitraClip include:
Common risks and complications that can occur 5 % of the time or more include:
- Bruising, swelling and pain, scarring, and/or loss of sensation around the access sites.
- Early or late failure of the procedure/device to reduce the amount of valve leak, reduce symptoms (especially if you have other medical conditions) or both. This may lead to reconsideration of open-heart surgery or repeat MitraClip procedure.
- Sore throat from the breathing tube, the echocardiography probe, or both.
- Development of an abnormal heart rhythm that can require treatment blood thinners, other drugs and possibly an electric shock to the heart.
- Post procedural memory loss or confusion (delirium) which usually resolves but can sometimes result in residual permanent reduced cognitive / brain function.
Uncommon risks and complications that can occur 1-5 % of the time include:
- Bleeding around the heart that requires emergency insertion of a tube into the space around the heart or open-heart surgery to prevent death.
- Inability to deploy the device.
- Blood clot formation in the leg (DVT) causing pain and swelling. Sometimes part of the clot can break off and go to the lungs, which can be life threatening.
- Infection of the wound, new heart valve or other organs (for example kidneys, bladder or lungs). This usually requires antibiotics (often into a vein) and can require a surgical procedure.
- Allergic reaction to drugs or contrast dye.
- Bleeding requiring blood transfusion or vascular surgical repair. The spread of an infection from a blood transfusion is possible but rare.
- Stroke leading to loss of function of limb movement, sensation, loss of vision or other senses or other disability or ever
Rare risks and complications that can occur less than 1% of the time include:
- Renal / kidney failure, especially if you have abnormal kidney function already or if you have diabetes. This can also lead to a requirement for temporary or permanent dialysis.
- Prolonged ventilation and subsequent respiratory failure and prolonged admission.
- Risks of a general anaesthetic, which rarely can lead to life threatening adverse reactions and death.
- The MitraClip device embolising / travelling into other parts of the body or heart and require major surgery to retrieve and / or require placement of an additional valve.
- Need for a temporary or permanent pacemaker.
- A hole in the food pipe or stomach as a result of the ultrasound probe being placed down your food pipe. This is rare (< 0.1%).
- The device causing too much narrowing of the valve leading to breathlessness and/or swelling. This may require open-heart surgery to repair.
- The device causing haemolysis and anaemia (low blood count).
- Unplanned open-heart surgery which can include valve surgery, bypass surgery or reconstructive surgery on the heart or blood pipes including with artificial materials. Any complication can lead to death.
- The procedure is performed using X-ray type radiation. Theoretically any radiation exposure can increase the life-time risk of cancer although this risk is more relevant for patients under the age of 40 years old. In addition, radiation exposure can be associated with skin changes (hair loss, colour change). Very rarely the radiation exposure can result in skin burns, non-healing ulcers and pain that can require surgical management.
Special considerations include:
- Although the transcatheter mitral valve repair is usually less traumatic than conventional open cardiac surgery it is still a major procedure with major and significant risks.
- As detailed above, because of the nature of this being a major invasive procedure some patients may have ongoing aches, pains, swelling and numbness for months or even forever after the procedure and not everyone fully recovers.
- The procedure is not a cure and will require ongoing follow-up with your specialist and treatment with medication therapy.
- This is a relatively new treatment, and as explained above the long-term durability is still somewhat unclear and will require ongoing follow-up with your specialist.
- Bacterial endocarditis alert: In the future, if you have any dental or surgical procedures, no matter how minor, you must tell your doctor. Prophylactic antibiotics should be taken before these procedures to prevent Endocarditis (infection of your heart valve) happening to you.