Transcatheter edge-to-edge mitral valve repair (MitraClip)

The mitral valve separates the left atrium from the left ventricle. When it no longer closes properly, some blood flows backwards with each heartbeat: this is mitral regurgitation. When severe, it causes breathlessness and fatigue and can lead to heart failure. Surgical repair remains the reference treatment when possible, but some patients are too frail for open-heart surgery. Transcatheter edge-to-edge repair attaches the two valve leaflets together at the site of the leak, using one or more small fabric-covered metal clips. The clip is brought through a vein at the groin, then crosses from the right atrium to the left atrium through the wall that separates them (transseptal puncture). The procedure is performed under general anaesthesia and is continuously guided by transoesophageal echocardiography and X-ray imaging. The indication is decided by a multidisciplinary team (the "heart team") of cardiologists, cardiac imaging specialists, cardiac surgeons and anaesthetists. It concerns severe, symptomatic mitral regurgitation when surgery is considered high risk, or certain leaks caused by an enlarged heart that persist despite optimal medical treatment. At Clinique Pasteur Tunis, the decision is based on this joint discussion, and the procedure is performed by a team of interventional cardiologists, an echocardiographer and anaesthetists, in a latest-generation catheterisation laboratory, with cardiac intensive care on site.