The mitral valve separates the upper and lower chambers on the left side of the heart and is designed to ensure that blood flows only in one direction from the left ventricle (the main pumping chamber) to the rest of the body. When this valve does not close as tightly as it should, a condition known as mitral regurgitation, blood leaks backward from the pumping chamber into the left atrium (the upper chamber). As a result, the heart has to work harder to pump blood around the body, leading to fatigue, shortness of breath, irregular pulse and other symptoms. Eventually, if left untreated, severe mitral valve regurgitation can cause irreversible heart failure.
Open heart surgery has been the standard treatment for mitral regurgitation and involves stopping the heart and keeping it pumping on a machine. For patients who are older or have other medical complications, the surgery can be risky and has a recovery time of one to three months.
Designed by Abbott Vascular, the MitraClip can be used for inoperable or high-risk surgical patients to provide lasting treatment for acute mitral regurgitation. In total, 12 MitraClip procedures have been performed over the last year at Sunnybrook by a team consisting of a cardiac surgeon, cardiologist and cardiac anaesthetist, supported by a specially trained nurse. A catheter is inserted into the patient's groin and travels up into the mitral valve. The clip is fed through this catheter, where it finally grasps and tightens the valves' leaflets, effectively preventing blood from leaking. The clip remains in place while the catheter is removed, with the entire procedure taking approximately four hours, and is performed under general anesthesia without the use of a heart-lung machine.
"The procedure itself is well tolerated and relatively low-risk, making it an ideal option for patients who are not suitable for traditional open heart surgery. We've seen firsthand the potential this has to improve the quality of life for many sick patients, enabling them to have a more active lifestyle," says Dr. Gideon Cohen, cardiac surgeon at Sunnybrook's Schulich Heart Centre, who has performed the MitraClip procedure with Dr. Eric Cohen, Deputy Head of the Division of Cardiology at Sunnybrook.
For André Séguinot, a retired professor, the procedure meant the difference between spending most of his day in bed to his current lifestyle of cycling, teaching judo and playing guitar in a jazz sextet. "It's a miracle," says André, who is 81 years old. "I went from being exhausted all the time and not able to walk very much to being active and having the energy to have the lifestyle that I want to have. The difference was unbelievable. And I was sent home the following day."
Funding for the MitraClip procedure comes from the Sunnybrook Foundation and each case costs approximately $36,000, with the therapy falling under Health Canada's Special Access Program.