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Blackrock Clinic CEO Blog State of the Art Transcatheter Mitral Valve Repair – MitraClip®, Abbott Vascular

State of the Art Transcatheter Mitral Valve Repair – MitraClip®, Abbott Vascular

3rd Sep 2019

Cardiac treatments are transitioning from lengthy open surgeries to minimally invasive surgical and transcatheter techniques. In July 2018, Blackrock Clinic launched a programme to establish our hospital as a centre of excellence for mitral valve edge to edge repair, or Mitraclip implantation.

Transcatheter techniques for mitral valve, third image

The MitraClip in position. Abbott (2019)

The MitraClip procedure is a minimally invasive catheter-based therapy performed by multidisciplinary heart teams designed for  patients presenting with leaking of the mitral valve or mitral regurgitation (MR). Open-heart surgery to repair or replace the mitral valve is generally recommended, but it is not an option for many patients.

High risk or inoperable patients with severe MR secondary to heart failure or valve degeneration, undergo the implantation of an Abbott Vascular Inc. patented device, the MitraClip, in a catheter laboratory (cath lab) environment. The treatment results in improvement in symptoms and quality of life and can have a significant impact on the rates of admission to hospital and mortality. The patients are currently a mix of men and women, with a mean age of around 80 years old.

Transcatheter techniques for mitral valve image 1

The MitrClip Delivery System. Anaesthesia & Analgesia (2014)

The system comprises a steerable guide catheter that is advanced from the femoral vein in the groin to the heart through which a clip  (MitraClip) is introduced to the mitral valve and which, when closed, brings the edges of the valve together, thereby reducing the leak.

Transcatheter techniques for mitral valve, image 2

The MitraClip – size comparison. Abbott (2019)

 

 

 

 

 

 

 

The MitraClip device was first used in the US in 2003, since then over 80,000 procedures have been performed worldwide.

The team

The Mitraclip team consists of two consultant interventional cardiologists specially trained in invasive endovascular and trans-septal procedure, and supported by an anaesthetist.

Interventional Cardiologists:

Imaging Cardiologist:

Cardiothoracic Surgeon:

Anaesthetists:

  • Dr Fionnula Lyons, and
  • Dr Fidelma Kirby.

The procedure

The procedure is performed under general anaesthetic in the cardiac cath lab setting. Real time 3-dimensional imaging plays a key role by allowing the physicians information regarding clip navigation and advancement of the system through to assessment of the final result.

Availability and costs

It is crucial that we get the backing of the health insurance companies when new treatment paths are developed. We work closely with our third party stakeholders to prevent delays in breakthrough procedures becoming an economically viable option for our patients. I am delighted to report that VHI has now agreed to cover the MitraClip Implantation procedure, making it accessible to patients at Blackrock Clinic.

The future

It is a very exciting time in the field of interventional cardiology and the transcatheter treatment approach. As a hospital with extensive on site ICU support, along with cardiac and vascular surgical back up, Blackrock Clinic is its ideal centre of excellence in Ireland. MitraClip implantation is a great addition to our repertoire.

Abbott. (2019). MitraClip Procedure | Transcatheter Mitral Valve Repair. [online] Available at: https://mitraclip.com/mitraclip-procedure/ [Accessed 2 Sep. 2019].

Anesthesia & Analgesia, volume 118(issue 6), pp1188-1196 (June 2014. [online] Available at: https://journals.lww.com/anesthesia-analgesia/fulltext/2014/06000/Transesophageal_Echocardiography_During_MitraClip_.8.aspx/ [Accessed 3 Sep. 2019].