MITRACLIP™

Can I eat or drink before my procedure?
You should fast at least 6 hours before your procedure.

Do I take my medications on the day of the procedure?
Unless advised by your doctor, you should continue to take your usual medications.

If you are taking anticoagulants, you will be asked to stop them 2 full days prior to your procedure. You may be required to have blood thinning injections (Clexane) until the day before the procedure as a bridge to stroke protection.

Where do I go to have the procedure?
MitraClip™ is performed at Peninsula Private Hospital in the cardiac hybrid laboratory (cath lab).

You will be admitted the day prior to your procedure to optimise your condition.

What do I need to bring?
It is recommended that you bring the following with you to the hospital:

• Your hospital admission paperwork with a signed consent form, health insurance details and Medicare /DVA card.
• Your current medications in their original containers.

An overnight bag with your belongings, as you will be required to remain in hospital for 1-2 days for monitoring after the procedure.

What happens during the procedure?
The procedure is performed under a general anaesthetic and guided by a transoesophageal echocardiogram. This is performed by a specialist cardiac anaesthetist. You will have an intravenous line inserted into your arm for IV fluids and drugs and arterial line for monitoring you blood pressure during the procedure.

The right groin vein is punctured with a needle and a sheath (tube) with a one-way valve is inserted into the vein, enabling us to carry the wires and catheter holding the device, to the heart.

The septum/muscle dividing the upper chambers is punctured with a needle which allows us entry into the left upper chamber (atrium)

A catheter is introduced into the left atrium and it is through this catheter, the MitraClip™ device is advanced to the mitral valve.  Under TOE (transoesophageal echocardiogram) guidance the MitraClip™ is carefully placed at the tips of the mitral valve leaflets.

After confirming the satisfactory position of the clip and mitral valve function, the clip is detached from the catheter.  Evaluation of the function of the treated valve via TOE at this time will determine the reduction of the mitral regurgitation. A second clip may be required and deployed if the valve area is suitable.

On completion, all catheters and sheaths are removed. Firm pressure is applied to the groin puncture site to stop any oozing of blood. The TOE probe and breathing tube will be removed and once awake and orientated, you will be transferred to the coronary care unit for observation and monitoring.

How long does the procedure take?
The procedure takes approximately 1-3 hours and you will remain in hospital for 1-2 days for monitoring.

What are the risks and complications?
The safety of MitraClip™ is well established, and the rate of complications is low, with high procedural success. However, up to 4.35% of patients have experienced major adverse events related to the MitraClip™ procedure.

All efforts are made to mitigate any risks associated with the procedure.

The procedure is thoroughly imaged and planned prior to the day. The strategy and treatment plan is presented and discussed at the structural cardiac meeting.

A cardiothoracic surgeon is available to support our cases should the rare need arise.

The risks associated with MitraClip™ are:

• There is a 5% risk of tearing the mitral valve leaflets resulting in worsening of the valve dysfunction.
• Damage to the femoral vein with catheter advancement into the heart.
• Residual leak in the mitral valve after the procedure that may not be suitable for a second clip and require subsequent surgery.
• Bleeding at the puncture site.

Mitral valve specific complications:

• Device dislodgement
• Entanglement of the clip with the chordae tendineae (fibrous bands connecting the valve to the heart muscle)
• Narrowing of the mitral valve (mitral stenosis)
• Stroke
• Multiple organ failure
• Death

Other complications include:

• TOE related: Trauma to teeth, trachea (windpipe) or oesophagus including a tear to oesophagus during passage and manipulation of the transoesophageal probe during the procedure requiring urgent surgical repair.
• Risks associated with general anaesthetic – vomiting, nausea etc.
• Contrast related allergic response and rarely renal (kidney) impairment if a high volume of contrast is required.

Your doctor will explain the risks to you prior to the procedure. You are encouraged to discuss any questions or concerns with your doctor, the structural heart nurse and your family prior to proceeding.

AFTER THE PROCEDURE

Monitoring
Your heart rate and rhythm, blood pressure and groin access site will be monitored in the coronary care unit.

You should have minimal discomfort however it is important you report any pain or discomfort in your chest, throat or groin following your procedure. If there are any concerns, a CT scan of the chest or ultrasound of the groin vein may be required.

Mild discomfort can be treated with anti-inflammatory or pain relief medications.
You will be able to get out of bed and mobilise within 4-6 hours of arriving at your room.

Follow up
A repeat echo will be performed the day after your procedure to check the function of the mitral valve.

When you are discharged from hospital you will be provided with paperwork for another Echocardiogram scheduled 4-6 weeks after your procedure.

Your cardiologist will review you 6-8 weeks after your procedure.

What will I need to do after I go home?
You can resume most gentle activities with exception of not driving for 48hrs.
You will continue taking all your discharge medications unless instructed otherwise.

If you have any questions or concerns relating to your procedure or pain or discomfort after discharge, contact our office on 03 9789 0088 and speak with one of the critical care nurses.

RESULTS
Your cardiologist will discuss the procedural outcome and any medication changes with you prior to discharge from hospital.

A copy of your procedural report will be sent to your referring doctor.