Transcatheter Mitral Valve Repair – MitraClip and PASCAL

The mitral valve is located between the left heart chambers (left atrium and left ventricle) and keeps blood flowing in the correct direction. Mitral regurgitation (MR) is a condition in which the mitral valve leaflets do not close tightly. When this happens, blood flows backward from the left ventricle into the left atrium. The heart must then work harder to push blood through the body, which can cause fatigue, shortness of breath and worsening heart failure.

There are several causes of mitral regurgitation and these include:

• Heart disease (such as heart attack), or other conditions that weaken the heart muscle
• Deterioration of valve tissue
• Congenital valve abnormalities

For mild cases, treatment may not be necessary but you will need to be monitored closely by your doctor. For more severe cases, options include medical treatment, surgery, or a less-invasive transcatheter mitral valve repair  (MitraClip or PASCAL therapies).

Symptoms depend on how advanced it is and how quickly it has developed. Some patients may not experience symptoms, but when present, they include:

• Shortness of breath, especially after exertion or when lying down
• Fatigue and exhaustion, especially during increased activity
• Cough, especially at night or when lying down
• Swelling of ankles and feet
• Sensations of a rapid, fluttering heartbeat

The MitraClip and PASCAL therapies are a form of minimally invasive procedure to treat moderate to severe mitral valve regurgitation. This procedure is reserved for patients who are not suitable for surgical repair/replacement.

In each procedure, a device is attached directly to your mitral valve, without opening your chest. To access the mitral valve, a catheter (a long, thin, flexible tube) is guided through a vein in your leg to reach your heart.

The device is passed through the catheter and is then clipped to the mitral valve, allowing the valves to close more completely and therefore helps to restore normal blood flow through the heart.

Images contributed by Abbott Vascular (MitraClip)

Images contributed by Edwards Lifesciences (PASCAL)

MitraClip or PASCAL Therapy – What to Expect

Patients with moderate to severe MR for consideration for mitral valve intervention are referred initially to a cardiothoracic surgeon who is involved in the MitraClip programme. If patients are deemed not suitable for surgery, referral will be made for consideration for Transcatheter Mitral Valve Repair (MitraClip or PASCAL therapy)

Patients who are considered for Transcatheter Mitral Valve Repair (MitraClip or PASCAL therapy) would then need to undergo some investigations. These include, but are not limited to:

1. Coronary Angiogram (within 12 months)
2. Ultrasound tests for the heart:
   • Transthoracic Echocardiogram (TTE)
   • Transeosophageal Echocardiogram (TEE)
3. Cardiopulmonary Exercise Test (CPET)
4. Blood Tests
5. Dental Clearance

Once these investigations are done, cases will be brought up at our Heart Team's discussions.

MitraClip/ PASCAL Therapy

Patients will be admitted one day before the procedure, and will be hospitalised for one to three days after the procedure. The procedure is done under general anaesthesia and takes approximately 3 to 4 hours. After the procedure, patient will be admitted to the Coronary Care Unit (CCU) to be monitored before being transferred to a general ward.

MitraClip/ PASCAL Therapy – Post-Procedure Care

Most patients do not need special assistance at home after the procedure (outside of ongoing needs for any related health conditions). There may be a bruise at the punctured site and some soreness when walking may be expected. The surgical wound at the groin should take about 2 weeks to heal. Patient will be on dual antiplatelet therapy (DAPT) for at least 3 months post-procedure.

Upon discharge, patients will be reviewed at NHCS outpatient clinic at 1 month, 6 months, 1 year and annually thereafter with a TTE and necessary blood tests done before each visit.

Video

Transcatheter Mitral Valve Repair: Mitraclip