If the mitral valve disease is mild, medicine will be prescribed to treat the symptoms. If the disease is more severe, the current preferred treatment is a surgical repair of the patient's valve. The surgeon accesses the heart through a sternotomy (opening of the chest bone) and excises or repositions the diseased valve leaflets. In instances where the valve is severely diseased, a surgeon will perform a valve replacement using a mechanical or bioprosthetic valve. For some patients, a minimally invasive surgical option is available where a mini or partial sternotomy is performed involving a smaller incision on the chest. The mitral valve is accessed between the ribs, therefore not requiring the breastbone to be spread. The advantage to surgery includes an improved quality of life and expanded life expectancy, as the flow to the heart becomes regulated.
MitraClip, catheter-based treatment, is available for patients with significant symptomatic degenerative mitral regurgitation and are too high risk for surgery. In this procedure, a metal clip is advanced on a catheter delivery system, most often through the femoral vein in the groin, and guided by a special type of x-ray into the mitral valve. The MitraClip device then clips the leaflets of the valve together to reduce the amount of blood that flows back into the left atrium. MitraClip is not FDA approved for patients with functional (ischemic) mitral regurgitation, although patients with this form of mitral valve disease may be eligible for the device through participation in the COAPT trial
Columbia University receives royalties from Abbott Vascular for sale of the MitraClip.
The Columbia Heart Valve Center is currently enrolling patients in the COAPT Trial. Eligible patients include patients who have been diagnosed with moderate-to-severe or severe functional mitral regurgitation (FMR) and who are too high-risk to undergo mitral valve surgery according to a cardiothoracic surgeon. The COAPT trial is a multicenter trial that randomizes patients to receive either the MitraClip device or medical therapy.
More information regarding the COAPT Trial.
Click here to view an animation of the MitraClip procedure:
Video courtesy of Abbott Vascular. 2013 Abbot Laboratories.
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