What is MitraClip?

MitraClip (Abbott) is a catheter-based device that clips the leaflets of a leaking mitral valve together, reducing mitral regurgitation (MR) without open heart surgery. It is delivered through the femoral vein, crosses the interatrial septum via transseptal puncture, and is guided to the mitral valve under continuous 3D transesophageal echocardiography. One or more clips are placed at the point of greatest regurgitation to create a double-orifice valve that significantly reduces the leak.

MitraClip is now one of the most commonly performed structural heart procedures worldwide, with over 200,000 patients treated. It is approved for both primary (degenerative) and secondary (functional) mitral regurgitation.

Primary vs. Secondary Mitral Regurgitation

Primary (Degenerative) MR

Primary MR is caused by a structural defect in the valve itself — most commonly mitral valve prolapse (MVP) where one or both leaflets bow back into the left atrium during systole. The 2021 ACC/AHA guidelines recommend MitraClip for symptomatic severe primary MR when the anatomy is suitable and surgical risk is elevated.

Secondary (Functional) MR

Secondary MR occurs when the valve is structurally normal but leaks because the ventricle is dilated or dysfunctional — pulling the leaflets apart. COAPT trial (2018) established MitraClip as a Class IIa recommendation for secondary MR in HFrEF patients with persistent severe MR despite optimal GDMT, demonstrating a dramatic 47% reduction in heart failure hospitalizations and improved survival.

Key Clinical Trial Evidence

COAPT (2018, NEJM)MitraClip reduces HF hospitalizations 47% and improves survival in secondary MR — landmark trial
MITRA-FR (2018)Neutral results for MitraClip in secondary MR — patient selection differences explain divergence from COAPT
EXPAND StudyReal-world MitraClip G4 registry confirms high procedural success and QoL improvement
RESHAPE-HF2 (2024)Additional RCT confirming MitraClip benefit in secondary MR — reinforces COAPT findings

Patient Selection for MitraClip

Not all MR anatomy is suitable for MitraClip. Key factors assessed on TEE and CT include: coaptation gap size, leaflet length and mobility, mitral valve area (must be large enough to accommodate clips without causing stenosis), presence of calcification at the grasping zone, and the mechanism of MR. Patients unsuitable for MitraClip may be candidates for surgical repair or the Tendyne / Intrepid transcatheter mitral replacement systems.

Frequently Asked Questions

What is the difference between MitraClip G4 and older generations?

MitraClip G4 XTR has longer grasping arms for leaflets that are difficult to grasp, and NT has narrower clips for smaller valves. The system has been continuously refined to expand the range of anatomy that can be treated successfully.

Can I have MitraClip if I've already had mitral valve surgery?

MitraClip can sometimes be performed after a prior surgical repair if the repair has failed. Valve-in-ring and valve-in-valve procedures for failed bioprosthetic mitral valves are also performed using transcatheter techniques at experienced centers.

How long does MitraClip last?

MitraClip clips are permanent implants. Long-term data (5+ years) show durable MR reduction in most patients. Recurrent MR can occur if the valve disease progresses or if the clip does not adequately reduce the initial leak.