What is a MitraClip?

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.

 
Figure 1: MitraClip

Figure 1.

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 even death.

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.
  • Death

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.

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 even death.

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.
  • Death

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.

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Unit 4, 60 Arnisdale Road, Duncraig, WA, 6023

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Suite 1/11 Council Avenue, Rockingham, WA 6168

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Royal Street Specialist Centre, Cnr Royal Street & Wanneroo Road, Yokine, WA 6060

0894803000

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136-138 Lockyer Avenue, Albany, WA 6330

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Augusta Hospital, 11 Donovan Street, Augusta WA 6290

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Suite 21, St John of God Hospital, Southwest Health Campus, Corner of Roberston Drive & Bussell Highway, WA, 6230

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19 Albert Street, Busselton WA, Australia

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Collie Hospital, Steere Street N, Collie, WA 6225

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Denmark Health Service, 50 Scotsdale Road, Denmark WA, Australia

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Dunn Bay Road, Dunsborough WA 6281, Australia

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Karratha Health Campus Outpatients Department 62 Balmoral Road KARRATHA WA 6714

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17 Farrelly Street, Margaret River WA, Australia

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Hedland Health Campus, Outpatient Department, Port Hedland WA 6721

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The Wesley Medical Centre, 1/40 Chasely St Auchenflower, Brisbane, QLD, 4066

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Chermside Medical Complex, Lower Ground Floor, 956 Gympie Road, Chermside QLD, 4032

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10 Mapleton Road, Nambour, QLD, 4560

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Bundaberg, Mater Hospital (Oncology), 313 Bourbong Street, Bundaberg, QLD, 4670

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Fraser Coast, St Stephen’s Private Hospital, 1 Medical Place, Urraween, Qld, 4655

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Rockhampton Hospital, Lower Ground Floor, Canning Street, Rockhampton, QLD, 4700

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St Andrew's Medical Centre Clinic, Level 2. 321 South Terrace, Adelaide, SA 5000

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284 Kensington Road, Leabrook, SA 5068

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Mulgrave Private Hospital, Suite 8, Churchill Consulting Suites, Blanton Drive, Mulgrave, VIC, 3170

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Level 2, 50 New Street, Ringwood VIC 3134

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Lilydale Private Consulting Suites, 475 Swansea Rd, Lilydale, VIC, 3140

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Balwyn Consulting Suites, 481 Whitehorse Rd, Balwyn VIC 3103

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Health and Wellness Centre Level 1, Suites 8-10, 20 Scholar Drive, Bundoora, VIC, 3083

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Suite 1, 1008 Doncaster Road, Doncaster East VIC 3109

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Suite 1, Warringal Private Hospital, 216 Burgundy Street, Heidelberg VIC 3084

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Level 4, Suite 22, Melbourne Private Medical Centre, Royal Parade, Parkville VIC 3052

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Whittlesea Specialist Centre, 79-81 Church Street, Whittlesea VIC 3757

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Unit 2 / 11 Gloucester Avenue, Berwick VIC 3806

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Langwarrin Suites 1 & 2, 35 Cranbourne-Frankston Road, Langwarrin VIC 3910

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Level 2, 2-9 Village Way, Lakeside Square Medical Precinct, Pakenham VIC 3810

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Oriel Place, Suite 3, Level 1 531 Sandgate Road Clayfield QLD 4011

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Ramsay Specialist Centre Suite 212, Level 2 Newdegate Street, Greenslopes, QLD, 4120

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Urraween Medical Centre, Suite 4/156 Urraween Road, Urraween QLD 4655

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Mater Private Clinic Suite 5.02 & 5.11, Level 5 550 Stanley Street South Brisbane QLD 4101

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Mount Ommaney Medical Centre Shop 6/171 Dandenong Road Mt Ommaney QLD 4074

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Suites 14 & 15, Sunshine Coast University Private Hospital, 3 Doherty Street, Birtinya QLD 4575

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Level 5, Suite 91 Sandford Jackson Building 30 Chasely Street Auchenflower QLD 4066

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Lavender House 37 William Street Beaudesert QLD 4284

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Rooms Bayside Level 1, The Hub Corner of Rickey & Loraine Street Capalaba QLD 4157

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Mater Hospital (Outpatients Department), 50 Rosella Street, Gladstone, QLD, 4680

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Gympie Specialist and Diagnostic Centre, 74 - 76 Channon Street, Gympie QLD 4570

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Jimboomba Medical Centre Shop 14, Jimboomba Shopping Centre Mt Lindesay Highway Jimboomba, Qld, 4280

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St Stephen's Medical Centre Suite 2, 166 John Street Maryborough QLD 4650

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Mater Hospital (Outpatients Department) 31 Ward Street Rockhampton QLD 4700

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Springfield

Priority Health Orion Shopping Centre, 1st Floor, 1 Main Street, Springfield QLD 4300

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St Vincent's Private Hospital, Toowoomba, Scott Street, Toowoomba City QLD 4350

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Floor 1, 19-23 Bingera Street, Bundaberg QLD 4670

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Cardiac Investigations Unit, Bundaberg Base Hospital, Bourbong Street, Bundaberg West, QLD, 4670

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Vermont Consulting Clinic, Vermont South Medical Centre, Level 3, Suite 3-5a, 645-647 Burwood Hwy, Vermont South, VIC, 3133

St Andrew's Medical Centre (Sleep Medicine)

level 2, 321 South Terrace, Adelaide SA 5000

Joondalup – Shenton House (Sleep Medicine)

Level 3, 57 Shenton Avenue, Joondalup WA 6027

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Suite 103, Specialist Medical Centre West, Grand Blvd & Shenton Ave, Joondalup, WA, 6027

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Suite 68-72 Wexford Medical Centre, Level 4, 3 Barry Marshall Parade, Murdoch WA 6150

Nedlands (Sleep Medicine)

Suite 20/21 Hollywood Medical Centre, 85 Monash Avenue, Nedlands WA 6009

Perth Mount (Sleep Medicine)

Suite 3 Mount Medical Centre, Level 3, 140 Mounts Bay Road, Perth WA 6000

Yokine (Sleep Medicine)

Royal Street Specialist Centre, Cnr Royal Street & Wanneroo Rd, Yokine WA 6060

Bunbury (Sleep Medicine)

Suite 21, St John of God Hospital, Southwest Health Campus, (Cnr Robertson Drive & Bussell Hwy), Bunbury WA 6230

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19 Albert Street, Busselton WA 6280, Australia

Mandurah - Sleep Medicine

1/5 Murdoch Drive, Greenfields WA 6210

Manjimup (Sleep Medicine)

Warren District Hospital, 1 Hospital Ave, Manjimup WA 6258

Lady Cilento Children's Hospital

501 Stanley St, South Brisbane, QLD 4101

Ballow Chambers Spring Hill

121 Wickham Terrace, Spring Hill QLD 4000

Royal Brisbane and Women's Hospital

Butterfield St, Herston QLD 4029

Ipswich

Boulevard Specialist Suites, 17 Limestone St, Ipswich, QLD 4305

North Lakes

9 McLenna Court, North Lakes QLD 4509

Nambour (Sleep Medicine)

Hospital Road, Nambour QLD 4560

Benowa

The Lung Centre, 144 Ashmore Rd, Benowa QLD 4217

Robina

481 Robina Towun Centre, Robina QLD 4230

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St Andrew’s Hospital, North Street, Spring Hill, QLD, 4000

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Mackay Rehabilitation Hospital, 57 Norris Road, North Mackay QLD 4740

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Hollywood Private Hospital, Diagnostic Nuclear Imaging, Monash Ave, Nedlands WA 6009

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Macquarie University Hospital, Macquarie Medical Imaging, 3 Technology Place, Macquarie Park NSW 2109

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890911081

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Sunshine Coast University Private Hospital Suite 20/3 Doherty St, Birtinya QLD, 4575

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Surrey Hills

Union Road Specialists Centre, 203 Union Road, Surrey Hills, VIC, 3127

balwyn@hcvic.com.au

Pulse Oceanside Medical

Pulse Oceanside Medical, Suite 402, 11 Eccles Boulevard, Birtinya, QLD 4575

Westside Private Hospital (Cardiology)

Westside Private Hospital, Suite 309, Level 3, 32 Morrow Street, Taringa, QLD, 4068

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