A Nonsurgical Treatment for Mitral Valve Disease

Physicians at Columbia’s Heart Valve Center are now offering a minimally invasive treatment for mitral valve regurgitation called the MitraClip. 

Until recently, open-heart surgery was the only option for treating this common condition that develops when the two flaps of the mitral valve fail to close properly. Because blood leaks backward through the valve with each heartbeat, blood flow to the rest of the body is impaired. Symptoms of heart failure, such as shortness of breath, chest pain, and fatigue, can develop. The leakage can be caused by a problem with the valve tissue itself (called degenerative) or because an otherwise normal valve is pulled apart by an enlarged or weakened heart pump (called functional).

The MitraClip, a tiny metal device inserted with a catheter, “grasps and clips the leaflets of the mitral valve together to significantly reduce or stop blood leakage,” says William A. Gray, MD, director of endovascular services and associate professor of medicine at CUMC. “Symptom relief is pretty remarkable and quite immediate.”

The heart beats normally during the procedure, so a cardiopulmonary bypass machine is not required. Most patients can go home the next day and resume their normal activities in less than a week. The recovery time for valve surgery, in contrast, can span a couple of months.

In late 2013, the FDA approved the MitraClip for use in patients with degenerative mitral regurgitation who are at high risk for surgery due to their age, frailty, or poor health. And for patients with functional mitral regurgitation, the Heart Valve Center is now enrolling participants in a trial that could lead to the use of the MitraClip in many more patients. 

“As the baby boomers age, we are seeing a rapidly increasing population of patients with functional mitral regurgitation. They are often very symptomatic and have a poor long-term prognosis,” says Susheel Kodali, MD, director of the center and associate professor of medicine at CUMC. 

The multicenter study, called COAPT, aims to evaluate MitraClip’s effectiveness in treating this type of mitral regurgitation. (Currently, the MitraClip is not approved by the FDA for patients diagnosed with this condition.)

All participants in the COAPT trial will receive standard medical therapy, such as medication and implantation of a pacemaker, and will be randomly assigned to receive the MitraClip or to continue with medical therapy.

“If we find out through the COAPT trial that the MitraClip helps to reduce hospitalizations or improve survival, it will make a huge difference for these patients,” says Dr. Kodali.