MitraClip Procedure

Introduction

If you have been told that your mitral valve is leaking and that open-heart surgery may be too risky for you, the MitraClip procedure is one of the options your heart team may be discussing. It is a catheter-based way to repair the valve without opening the chest, and it has become an established treatment for selected patients with moderate-to-severe or severe mitral regurgitation (a leaky mitral valve).

This guide is written for patients and families who already know that mitral regurgitation is part of the picture, and who are now trying to understand what the MitraClip procedure involves, who it suits, what alternatives exist, and what life looks like afterwards. It does not replace the conversation with your cardiologist and cardiac surgeon, but it should help you walk into that conversation with clearer questions.

What Is the MitraClip Procedure?

The MitraClip procedure is a minimally invasive treatment for a leaking mitral valve. The clinical name for the technique is transcatheter edge-to-edge repair, often shortened to TEER or M-TEER (mitral TEER). MitraClip is the most widely used and longest-studied device used for this purpose; other devices using the same principle also exist.

Instead of opening the chest and stopping the heart, doctors guide a thin tube (catheter) through a vein in the leg up to the heart. A small implanted clip is then placed on the two flaps (leaflets) of the mitral valve, joining them together at one point. This creates a smaller double opening in the valve and reduces the backward leak of blood.

Cross-section of the heart showing: ① left atrium, ② mitral valve leaflets, ③ MitraClip device joining the leaflets, ④ double orifice created by the clip, ⑤ left ventricle.

*AI-generated image - for illustration only. Clinical accuracy is not guaranteed.

Key features of the procedure:

• It is catheter-based — there is no large chest incision and no breastbone cut.
• The heart keeps beating during the procedure; a heart-lung bypass machine is not used.
• It is performed in a catheterisation lab or hybrid operating room under general anaesthesia.
• It is most commonly offered to patients who are at high or prohibitive risk for conventional mitral valve surgery, or for whom surgery is not the preferred option.

A brief reminder about mitral regurgitation

Side-by-side comparison showing: ① normal mitral valve closed, ② primary regurgitation with prolapsed leaflet causing leak, ③ secondary regurgitation with tethered leaflets causing central leak.

*AI-generated image - for illustration only. Clinical accuracy is not guaranteed.

• Primary (degenerative) mitral regurgitation — the valve itself is structurally abnormal, for example because of prolapse or a torn supporting cord (chord).
• Secondary (functional) mitral regurgitation — the valve leaflets are essentially normal, but the heart muscle or the ring around the valve is enlarged or weakened, often from heart failure or after a heart attack. The leaflets cannot meet properly.

Untreated severe mitral regurgitation can lead to worsening breathlessness, repeated hospital admissions for heart failure, atrial fibrillation, and reduced survival. This is the background against which the MitraClip procedure is considered.

Why Is the MitraClip Procedure Performed?

The goal of the MitraClip procedure is to reduce the leak across the mitral valve so that the heart and lungs are under less strain. In selected patients this leads to fewer heart failure symptoms, fewer hospital admissions, and improved day-to-day function.

Doctors typically consider the procedure when:

• Mitral regurgitation is moderate-to-severe or severe.
• The patient has symptoms — most often breathlessness on exertion or when lying flat, fatigue, swollen ankles, or repeated heart failure admissions — despite optimal medical therapy.
• Open-heart mitral valve surgery is judged to be too risky, not feasible, or not the preferred option after careful evaluation.
• The anatomy of the valve is suitable for clip placement, as judged by detailed imaging.

Major guideline bodies, including the American College of Cardiology and American Heart Association (ACC/AHA) and the European Society of Cardiology / European Association for Cardio-Thoracic Surgery (ESC/EACTS), describe transcatheter edge-to-edge repair as a recognised option in these settings. For patients with secondary mitral regurgitation due to heart failure, guidelines specifically note that the procedure should be considered in carefully selected patients whose symptoms persist on the best possible heart failure medical therapy.

Who Is a Candidate?

Not everyone with a leaking mitral valve is a candidate for the MitraClip procedure. Selection is done by a heart team — typically an interventional cardiologist, a cardiac surgeon, a heart failure cardiologist, and a cardiac imaging specialist. They look at the whole picture, not just the valve.

Factors that support candidacy

• Severe symptomatic mitral regurgitation that is making daily life difficult.
• High or prohibitive surgical risk because of age, frailty, kidney disease, lung disease, previous heart surgery, or other major conditions.
• For secondary (functional) mitral regurgitation: persistent symptoms despite well-optimised heart failure medications and, where appropriate, cardiac resynchronisation therapy (CRT).
• Mitral valve anatomy that is suitable for the clip: leaflets long enough to grasp, valve opening wide enough that clipping will not cause significant narrowing (stenosis), and no heavy calcification at the grasp site.
• Reasonable life expectancy and likelihood of benefiting from symptom improvement.

Factors that may make the procedure less suitable

• Active infection of the heart valves (endocarditis).
• Severe calcification or structural features of the valve that would prevent secure clip placement.
• A mitral valve opening that is already too narrow.
• Very advanced, fixed pulmonary hypertension or end-stage heart failure where benefit is unlikely.
• Inability to take the blood-thinning medications used around the procedure.

Before any decision, you will usually have a detailed transthoracic and transoesophageal echocardiogram so the team can study the valve from multiple angles. Whether the procedure is appropriate for you is a clinical judgment that the heart team makes together with you.

Alternatives to the MitraClip Procedure

Comparison of mitral valve treatment approaches: ① transcatheter clip repair (MitraClip), ② open surgical repair with annuloplasty ring, ③ surgical valve replacement with prosthetic valve.

*AI-generated image - for illustration only. Clinical accuracy is not guaranteed.

Optimal medical therapy

For secondary mitral regurgitation in particular, the first step is always to make sure heart failure medications are at the doses shown to help. This usually includes a combination of:

• Beta blockers
• ACE inhibitors, angiotensin receptor blockers, or angiotensin receptor-neprilysin inhibitors (ARNI)
• Mineralocorticoid receptor antagonists (such as spironolactone or eplerenone)
• SGLT2 inhibitors
• Diuretics to control fluid build-up

Cardiac resynchronisation therapy (a special pacemaker) may also be considered if the electrical pattern of the heart is suitable. Sometimes, optimising medical therapy alone improves the regurgitation enough that no procedure is needed straight away.

Surgical mitral valve repair

For most patients with primary (degenerative) mitral regurgitation who are at acceptable surgical risk, surgical repair through open-heart surgery remains the preferred treatment in major guidelines. A skilled surgeon can often reconstruct the valve using techniques such as resection of a damaged leaflet segment, placement of artificial chords, and a supporting ring (annuloplasty). Long-term durability of surgical repair is well established.

Surgical mitral valve replacement

When the valve cannot be repaired, it can be replaced with either a mechanical valve (very durable but requires lifelong blood-thinning medication) or a biological (tissue) valve (shorter lifespan but no long-term anticoagulation in most cases). Replacement may be done through a traditional sternotomy or, in selected centres, through smaller minimally invasive incisions.

Other transcatheter options

The field of transcatheter mitral valve therapy is expanding. Depending on anatomy and what is available locally, other options may include:

• Other transcatheter edge-to-edge repair devices that work on the same principle as MitraClip.
• Transcatheter mitral annuloplasty devices that reshape the valve ring.
• Transcatheter mitral valve replacement (TMVR), which is still evolving and currently used in specific situations such as a failed previous bioprosthetic valve or a previous surgical ring.

Patient in a clinical setting during a transoesophageal echocardiogram with a specialist guiding the procedure.

*AI-generated image - for illustration only. Clinical accuracy is not guaranteed.

Once the heart team agrees the MitraClip procedure is appropriate, a structured preparation phase follows. The exact steps vary between hospitals.

Tests and assessments

• Transthoracic echocardiogram (TTE) — an ultrasound of the heart from the chest wall.
• Transoesophageal echocardiogram (TEE) — a more detailed ultrasound from a probe in the food pipe; this is the key test for planning clip placement.
• Cardiac CT scan in selected cases to study valve anatomy and the heart chambers.
• Coronary angiography if there is any concern about blocked coronary arteries.
• Blood tests, including kidney function, blood counts, and clotting.
• Electrocardiogram (ECG) and assessment of any rhythm problems.
• Frailty and fitness assessment, often including a six-minute walk test and a careful review of other medical conditions.

Medication adjustments

Your team will review every medication you take. Some changes are common:

• Blood thinners and antiplatelet drugs may be paused or adjusted on a specific schedule.
• Diabetes medications and some heart medications may need short-term changes around the day of the procedure.
• You should not stop or change any medication on your own; follow the written instructions from the team.

The day before and the morning of the procedure

• You will usually be admitted the day before or on the morning of the procedure.
• You will be asked not to eat or drink for several hours beforehand (typically 6–8 hours).
• The team will confirm your identity, the planned procedure, allergies, and consent.
• You may be asked to shower with an antiseptic wash and remove jewellery, dentures, and nail polish.

What Happens During the MitraClip Procedure

Multi-panel overview of the MitraClip procedure: ① catheter inserted via femoral vein, ② catheter advanced to the right atrium, ③ transseptal puncture into the left atrium, ④ clip positioned above the mitral valve, ⑤ leaflets grasped and clip released.

*AI-generated image - for illustration only. Clinical accuracy is not guaranteed.

Anaesthesia and monitoring

The procedure is performed under general anaesthesia in most cases. You will be asleep throughout. Tubes and lines are placed for breathing support, fluids, and monitoring of blood pressure, oxygen, and heart rhythm. A small probe is gently placed in the food pipe to give continuous detailed images of the valve (transoesophageal echocardiography).

Vascular access

The interventional cardiologist makes a small puncture in the femoral vein at the top of the leg. A series of catheters is then advanced through this vein up to the heart. There is no cut on the chest.

Transseptal puncture

Positioning the clip

The delivery system carrying the MitraClip device is guided over the leaking part of the mitral valve. Using continuous echocardiography and X-ray imaging, the doctor aligns the clip precisely above the leak.

Grasping the leaflets

Checking the result

If the leak has been reduced enough and the valve is not too narrowed, the clip is released. If the result is not satisfactory, the clip can be repositioned, or a second (and occasionally third) clip may be added. The team aims for the best balance between reducing the leak and avoiding new narrowing of the valve.

Finishing up

Once the team is satisfied, the catheters are removed. The puncture site in the groin is closed with stitches, a closure device, or manual pressure. You will then be moved to a recovery area or a cardiac care unit for monitoring.

Recovery and Healing

Recovery timeline after the MitraClip procedure: ① waking in recovery room, ② monitoring on cardiac unit, ③ hospital discharge (day 1–3), ④ light activity at home, ⑤ groin site healed and strenuous activity resumed, ⑥ first follow-up echocardiogram.

*AI-generated image - for illustration only. Clinical accuracy is not guaranteed.

In hospital

• You will wake up in a recovery area and then be transferred to a cardiac unit. Many patients do not need an intensive care unit stay, but some do, especially those with heart failure.
• The leg used for access is kept still for several hours to allow the puncture site to seal.
• You will have repeat echocardiograms to confirm the position of the clip and check valve function.
• Typical hospital stay is one to three days, though it can be longer if heart failure needs more treatment.

The first few weeks at home

• Light walking and normal daily activities can usually be resumed within a few days.
• Heavy lifting and strenuous activity are typically avoided for one to two weeks while the groin puncture site heals.
• You may feel tired for some time; energy levels often improve gradually as the heart adjusts.
• You will be given a clear medication plan, which usually includes blood-thinning or antiplatelet medication for a defined period to lower the risk of clots forming on the new clip.

Follow-up

Follow-up is usually structured around regular clinic visits and echocardiograms — for example at one month, six months, and one year, then yearly. Heart failure medications continue to be adjusted as needed. Dental care and any future surgery will need awareness of the implanted clip; your cardiologist will give you guidance about infection prevention.

Risks and Complications

The MitraClip procedure is generally well tolerated, and in the patient groups for whom it is offered, the overall risk profile is favourable compared with open-heart surgery. However, no heart procedure is without risk. Knowing the possible complications helps you weigh the decision and recognise problems early.

Possible complications during or shortly after the procedure

• Bleeding or bruising at the groin puncture site; occasionally a larger blood collection (haematoma) or damage to the vein or artery.
• Residual mitral regurgitation — the leak may be reduced but not abolished; in some cases the result is less than hoped for.
• Mitral stenosis — narrowing of the valve from the clip; the team works to avoid this.
• Clip-related issues such as partial detachment from one leaflet (single leaflet device attachment) or, rarely, embolisation (movement of the device).
• Heart rhythm disturbances, including atrial fibrillation.
• Pericardial effusion or tamponade — bleeding around the heart, which can occur after the transseptal puncture and may need drainage.
• Stroke — uncommon but a recognised risk of any procedure inside the left side of the heart.
• Infection, including very rare infection of the valve or clip (endocarditis).
• Need for emergency cardiac surgery — very uncommon but possible if a serious complication arises.
• Anaesthesia-related risks, particularly in frail patients.

Longer-term considerations

• The leak may worsen again over time. Some patients eventually need an additional clip, valve surgery, or other intervention.
• The underlying heart condition — especially in secondary mitral regurgitation — usually continues to need active management.
• Bleeding from blood-thinning medications, especially in older adults, is a concern that needs ongoing review.

Your team will explain how these risks apply to your specific situation. The benefit of the procedure has to be weighed against these risks and against the risks of leaving the regurgitation untreated.

Life After the MitraClip Procedure

Many patients who have a successful MitraClip procedure notice meaningful improvement in symptoms over the first weeks and months. Breathlessness, fatigue, and swelling often ease, sleep can improve, and everyday activities such as walking, climbing stairs, and household tasks may feel easier.

What life looks like after the procedure depends a lot on the underlying problem.

If you had primary (degenerative) mitral regurgitation

The clip has addressed the structural problem with the valve. With a good result, symptoms can improve substantially. You will still need regular follow-up with echocardiograms to make sure the clip remains well positioned and that the leak is well controlled.

If you had secondary (functional) mitral regurgitation

The clip has reduced the leak, but the underlying heart muscle problem continues to need ongoing care. This means:

• Continuing all heart failure medications at the best tolerated doses.
• Daily weight monitoring and salt and fluid limits if your team has advised them.
• Cardiac rehabilitation, where available, to safely rebuild exercise capacity.
• Attention to other conditions such as diabetes, kidney disease, and sleep apnoea.

In landmark clinical trials of transcatheter edge-to-edge repair for heart failure patients with secondary mitral regurgitation, selected patients have shown reductions in heart failure hospitalisations and improvements in quality of life. The benefit was clearest when the regurgitation was severe relative to the size of the left ventricle and when medical therapy had already been optimised. These trials inform current guideline recommendations.

Lifestyle and ongoing care

• Activity: Gradual return to walking and other gentle aerobic activity is generally encouraged once your team confirms it is safe.
• Diet: A heart-friendly eating pattern — limiting salt, processed foods, and excess fluid if you have heart failure — supports the work of the medications.
• Smoking and alcohol: Stopping smoking and limiting alcohol are important parts of long-term heart health.
• Vaccinations: Influenza and pneumococcal vaccination are commonly recommended for people with heart disease; your doctor will advise.
• Dental and other procedures: Tell every doctor and dentist that you have a mitral clip. Ask about whether antibiotic prophylaxis is needed before specific procedures.
• Future imaging: The clip is generally safe for MRI scans, but always inform the imaging team in advance.

Signs that should prompt prompt medical review

• New or worsening breathlessness, especially at rest or when lying flat.
• Rapid weight gain (for example more than 2 kg in a few days) or new swelling of the legs.
• New or persistent palpitations, very fast or irregular heartbeats, fainting, or near-fainting.
• Chest pain, signs of stroke (sudden weakness, slurred speech, facial droop, vision change), fever, or signs of infection at the groin site.

Frequently Asked Questions

Is the MitraClip procedure the same as open-heart surgery?

No. Open-heart surgery involves a chest incision, the use of a heart-lung machine, and direct surgical repair or replacement of the valve. The MitraClip procedure is performed through a vein in the leg, while the heart keeps beating. It is generally less physically demanding to recover from, but it is suited to different patients and is not a direct substitute for surgery in every case.

Will the leak be completely fixed?

The aim is to reduce the leak substantially, not always to eliminate it. Many patients are left with a small amount of residual regurgitation, which is usually well tolerated. How much the leak is reduced depends on valve anatomy and how the clip sits.

How long does the clip last?

The clip itself is designed to remain in place permanently. Over time, the body's own tissue grows over it. The valve can change with time, however, and in some patients the leak may worsen again. Long-term follow-up with echocardiograms tracks this.

Can I have an MRI scan after a MitraClip?

The MitraClip is generally considered safe for MRI scans under standard conditions, but always inform the radiology team before any scan so they can check the specific device details.

Will I still need to take heart medications?

Yes. Most patients continue medications for heart failure, blood pressure, or rhythm control. Patients with secondary mitral regurgitation, in particular, are usually advised to keep taking optimised heart failure therapy. You will also typically be on blood-thinning or antiplatelet medications for a defined period after the procedure.

Can I fly or travel after the procedure?

Most patients can travel again once their team confirms recovery is on track, usually within a few weeks. Your cardiologist will give you specific advice based on your overall health and any heart failure status.

Can the procedure be repeated if the leak comes back?

In selected patients, an additional clip can be placed if regurgitation worsens later. In other cases, surgery or other transcatheter options may be considered. The right next step depends on anatomy, overall health, and the cause of the recurrent leak.

Is age a barrier to having the procedure?

Age alone is not a strict barrier. The MitraClip procedure is often used in older adults precisely because they may be at higher risk from open-heart surgery. What matters more than age is overall health, frailty, valve anatomy, and the likelihood of meaningful benefit. These judgments are made by the heart team together with you and your family.

Conclusion

The MitraClip procedure has given heart teams a way to treat a leaking mitral valve in patients for whom open-heart surgery is too risky or not the preferred option. By placing a small clip on the valve leaflets through a catheter, the procedure aims to reduce the leak, ease symptoms, and lower the burden of heart failure admissions in carefully selected patients.

It is not the right answer for everyone with mitral regurgitation. Surgical repair remains the preferred treatment for many patients with degenerative disease at acceptable surgical risk, and well-optimised medical therapy is the foundation of care in secondary regurgitation. Whether the MitraClip procedure is appropriate for you is a decision made by your heart team, based on the cause of the leak, the anatomy of your valve, your overall health, and your own goals. Understanding what the procedure involves — and what its limits are — is an important step in making that decision with confidence.