Transcatheter Edge-to-Edge Repair: A Detailed Guide

In the realm of cardiovascular medicine, significant advancements continue to reshape the landscape of treatment options for patients with heart valve disorders. From angioplasty and atherectomy to the TAVR procedure, cardiac procedures have grown by leaps and bounds.

One groundbreaking technique that has gained prominence in recent years is Transcatheter Edge-to-Edge Repair (TEER). This innovative procedure offers a less invasive approach to address mitral valve regurgitation, revolutionizing the field and providing hope to countless individuals suffering from this condition.

Mitral Valve Regurgitation: A Closer Look

Mitral valve regurgitation occurs when the mitral valve, located between the left atrium and the left ventricle of the heart, fails to close properly. As a result, blood flows backward into the atrium during ventricular contraction, reducing the heart’s efficiency and potentially leading to symptoms such as fatigue, shortness of breath, and heart failure. It is a serious condition that requires proper diagnosis and should be treated by the best interventional cardiologists. 

Traditionally, surgical intervention, such as open-heart surgery, has been the standard treatment for severe mitral regurgitation. However, TEER offers a compelling alternative that minimizes risks and maximizes patient outcomes.

What is Transcatheter Edge-to-Edge Repair (TEER)?

TEER is a catheter-based procedure that utilizes a small, flexible device to repair the mitral valve. The procedure is typically performed in a cardiac catheterization lab under fluoroscopic guidance without the need for a sternotomy or cardiopulmonary bypass. This less invasive approach significantly reduces surgical trauma and the associated risks, making it a viable option for patients who may not be ideal candidates for open-heart surgery due to their age or underlying health conditions.

The cornerstone of TEER is the MitraClip® device, developed by Abbott. The MitraClip® is a tiny metal clip with grasping arms that is delivered to the heart via a catheter inserted through a small incision in the groin. The clip is then carefully maneuvered into position, where it grasps the edges of the mitral valve leaflets, effectively reducing the regurgitant flow by bringing the edges together. This “edge-to-edge” repair technique mimics the results achieved through traditional surgical methods but without the associated risks of a more invasive procedure.

Benefits and Limitations of TEER

The advantages of TEER are numerous and compelling. Firstly, the procedure can be performed by the best interventional cardiologist under local anesthesia, avoiding the need for general anesthesia, which carries its own set of risks. 

Secondly, the recovery time for TEER is significantly shorter compared to traditional surgery, allowing patients to return to their daily activities more quickly. TEER has also been shown to provide excellent clinical outcomes, with studies demonstrating a reduction in mitral regurgitation severity, improvement in symptoms, and overall quality of life.

One of the key strengths of TEER lies in its versatility. The technique can be used to treat patients with both primary (degenerative) and secondary (functional) mitral regurgitation. Abnormalities in the valve leaflets cause primary mitral regurgitation, while secondary mitral regurgitation occurs due to underlying heart conditions such as left ventricular dysfunction. TEER has demonstrated efficacy in both scenarios, providing a viable treatment option for a wide range of patients.

It is worth noting that while TEER is a remarkable advancement in the field of cardiovascular medicine, it is not suitable for all patients with mitral regurgitation. The decision to pursue TEER or opt for traditional surgery is complex and requires a comprehensive evaluation by a multidisciplinary heart team of the best interventional cardiologists and cardiac surgeons. 

Factors such as the severity of regurgitation, valve anatomy, patient comorbidities, and the overall risk-benefit profile need to be carefully considered to determine the most appropriate course of action.

Moreover, TEER is a complex procedure that carries the risk of certain complications. These can include damage to the mitral valve leaflets or adjacent structures, embolization (dislodgement) of the MitraClip® device, bleeding, infection, or the need for additional interventions during or after the procedure. 

It is a relatively new technique, and the proficiency and experience of the operator performing the procedure can significantly influence its success. The learning curve associated with TEER requires specialized training and expertise to ensure optimal patient outcomes. That makes it crucial to consult with the best cardiologist in India before undergoing the procedure.

In Conclusion

Transcatheter Edge-to-Edge Repair (TEER) has emerged as a game-changing technique in the management of mitral valve regurgitation. By offering a minimally invasive alternative to open-heart surgery, TEER provides hope to patients who were previously considered ineligible for surgical intervention. 

With its excellent clinical outcomes, shorter recovery time, and versatility in treating various forms of mitral regurgitation, TEER represents a significant milestone in the evolution of cardiovascular medicine, ensuring that patients receive the best possible care while minimizing risks and optimizing their quality of life.

Dr. C Raghu is a renowned heart specialist in Hyderabad who has treated countless patients with cardiovascular diseases. He specializes in interventional cardiology and is regarded as one of the top cardiologists in India. If you or anyone you know has been diagnosed with mitral valve regurgitation and is planning to undergo TEER, feel free to consult with Dr. Raghu today.