Mitral Valve Repair & Replacement

Overview

Researchers are exploring less-invasive, catheter-based approaches for repairing and replacing the mitral valve, one of the four heart valves that keep blood flowing in the right direction.

Transcatheter edge-to-edge repair for mitral valve regurgitation

In recent years, the U.S. Food and Drug Administration (FDA) has approved a few innovative transcatheter treatment options for mitral valve regurgitation (or leakage) without the need for open-heart surgery: the MitraClip Delivery System (approved in 2013) and the PASCAL Precision Transcatheter Valve Repair System (approved in 2022).

Both procedures work similarly and are equally safe and effective. A recent study compared the two procedures.¹ The MitraClip and PASCAL procedures follow this basic process:

1. An interventional cardiologist uses a thin, plastic tube called a catheter to implant a large tube called a sheath into the patient’s vein in the patient’s groin (femoral vein). Through the sheath another tube called a catheter is passed from the right side of the heart to the left side of the heart through the tissue by creating a path through the tissue called the septum (Trans-septal) Once the catheter is in place, the clip may be advanced through this catheter.
2. After the clip device is threaded up to the patient’s heart, the cardiologist then implants the clip device into position directly over the center of the two tissue flaps, or leaflets, of the mitral heart valve, which is the valve that controls blood flow between the top-left (atrium) and bottom-left (ventricle) chambers of the heart.
3. Once properly implanted, the clip device can grasp the two flaps together to reduce the backflow of blood through the valve (mitral regurgitation).
4. After the cardiologist ensures the clip device is firmly in place, the cardiologist detaches the clip device from the catheter and removes the catheter from the patient’s body. 

When comparing the two procedures, the main differences come down to each clip device's physical and technical properties (i.e., size and structure, material construction of each device, etc.)² If you have mitral regurgitation and need a mitral valve repair, discuss the MitraClip and PASCAL procedures with your doctor to determine which procedure is the best treatment option for you.

Other devices in the pipeline

Another catheter-based approach, annuloplasty, delivers a device via a catheter to change the size and shape of the ring of tissue that circles the valve (mitral annulus). Like cinching a belt, the mitral annulus is tightened so the mitral leaflets will close properly. Another device being studied is evaluating the safety and efficacy of planting a spring-type device in the coronary sinus, which runs behind the mitral valve, to alter the annulus's shape and size and encourage the valve leaflets to close properly. This device and others are still under investigation and are not yet approved by the FDA.

With technology so rapidly changing the treatment options for patients with heart valve problems, it’s more important than ever to discuss your options with your doctor.

Valvuloplasty for mitral valve stenosis

Mitral valvuloplasty is a non-surgical procedure that may be used to open a narrow mitral valve within the heart, also known as mitral valve stenosis.

References

1. Cardiovascular Business
2. Dr. Konstantinos Spargias, “MitraClip vs. PASCAL Similarities and Differences”