Mitral valve clipping fast replacing open heart procedure in India

Once upon a time, the only option to treat heart diseases was open heart surgery. As technology developed, the possibilities for treating heart conditions through minimally invasive procedures have also increased, bringing down the recuperation period and complications.

One such heart condition for which treatment has advanced is mitral valve regurgitation. In this condition, the valve between the left heart chambers does not close fully, and as a result, blood leaks backward across the valve. This was normally treated with open heart surgery, and in the last 10 years, the option for mitral valve clipping has become available in India.

“Until about 20 years ago, the treatment for the condition was open heart surgery. Mitral valve clipping is relatively a new procedure launched around 20 years ago. It has been available in India for the last 10 years,” said Dr Rajesh Thachathodiyl, head of cardiology, Amrita Hospital, Kochi.

In cases where open heart surgery is not suitable, a transcatheter mitral valve intervention is helpful. Mitral valve clipping is a non-surgical way of treating the leak in the mitral valve, through clipping. The clip closes the valve, stops the leakage and helps prevent or minimise the amount of regurgitation through the valve.

“Unlike traditional surgery, it doesn’t require opening the chest. Rather, this is a keyhole procedure where the mitral valve is accessed with a thin tube (catheter) that is guided through a vein in your leg to reach the heart. One or two small clips are implanted in the valve cusps restricting the leak and restoring normal blood flow in the heart.

It thereby improves mitral valve-related heart failure symptoms and quality of life in most patients,” said Dr Dibya Ranjan Behera, senior consultant in cardiology at AMRI Hospitals, Bhubaneswar. The procedure, technically, is called transcatheter edge-to-edge repair (TEER). “Earlier, the only option available to treat the damage in the mitral valve was open heart surgery to replace and repair the original valve with an artificial valve.

Mitral valve clipping is a technology that replaces open heart procedure,” said Dr Jacob George, senior cardiologist at Rajagiri Hospital, Ernakulam, adding that a small metal clip is implanted into the mitral valve via the vein in the leg to reach the heart. “Mitral valve clipping is recommended for patients who are not fit for open cardiac surgery and for the ones whose heart’s pumping ability is below 40%,” said Dr Keshava R, senior director, interventional cardiology, Fortis Hospital, Bengaluru.

“The procedure is done in the cath lab. We pass a kind of device through the vein in the leg all the way up to the heart and enter the heart. There is a mechanism to deliver the clip. We use clips to close the leakage in the mitral valves,” said Dr Rajesh. Some patients may need two or three clips, while some people require only one clip.

The procedure is a good option for the elderly population and people with comorbidities. “In elderly people, those who are at higher surgical risk and people with comorbidities like kidney disease or diabetes, open-heart surgery can be a problem because of its complications. These people can undergo the treatment very safely,” he added.

“Mitral valve clipping is not feasible in all patients. Therefore, patient selection is very important. With the right patient, the treatment is highly effective,” said Dr Jacob. The whole procedure lasts about one or two hours. “As no complex procedure is involved in the treatment, the procedure will be completed in one to two hours.

The patient can leave the hospital in two days and can return to normal life within a short span,” Dr Rajesh added. The recovery period is low for the treatment. “Only minimal medications and follow-ups are required after the procedure,” according to Dr Jacob, adding that the cost, compared to open heart surgery, is high. “The cost is a big constraint. The treatment is available everywhere.

However, a lot of people do not choose the treatment option due to the cost. Mitral valve clipping may cost around Rs 20 lakh while the surgical (open heart) treatment costs only around Rs 4 lakh – Rs 5 lakh,” said Dr Rajesh. Dr Keshav said that the cost is a major issue in mitral valve clipping as the cost of the clip itself is over Rs 20 lakh, and add to it surgical costs.

“Sometimes, patients may need more than one clip to plug the leakage. As of now, we have only one company that is supplying the clips.” For people who have no cost constraint, this is a useful procedure. “As the recovery time required after the procedure is very less, people who have difficulty staying at the hospital or want to join work can avail of this treatment option,” he added. The costs may come down gradually over the years once the treatment gains popularity, Dr Jacob added. New Indian Express