Reparación de válvula mitral por vía transcatéter

When the mitral valve does not close completely, blood leaks backward from the left ventricle into the left atrium with each beat — mitral regurgitation. A severe leak forces the heart to pump the same blood repeatedly, and over time causes breathlessness, fluid retention, atrial fibrillation and heart failure.

Transcatheter edge-to-edge repair treats this without opening the chest. A catheter is advanced from a vein in the groin into the left atrium, and a small clip is placed to grasp the two valve leaflets together at the point where they fail to meet. The valve is left with two smaller openings instead of one leaking one, and the backward flow is substantially reduced.

Candidacy depends on which kind of regurgitation you have, and the distinction drives the whole discussion:

Primary (degenerative) regurgitation means the valve itself is damaged — commonly a prolapsing or flail leaflet. Surgical repair is highly durable and remains the preferred treatment when a patient can undergo it. Transcatheter repair is offered when surgical risk is prohibitive.

Secondary (functional) regurgitation means the valve leaflets are structurally normal but the left ventricle has enlarged and pulled them apart. Here the underlying problem is the heart muscle. Transcatheter repair is considered for selected patients who remain symptomatic despite optimized heart failure medication and appropriate device therapy — and getting that medical therapy right first is what determines who benefits.

A heart team including an interventional cardiologist, a cardiac surgeon and a heart failure specialist makes this decision together. A transesophageal echocardiogram is essential to confirm the anatomy is suitable, since not every valve can be clipped.

The procedure is performed under general anesthesia with continuous transesophageal echocardiographic guidance, and typically takes two to three hours. A catheter passes from the femoral vein into the right atrium and across the wall between the atria into the left atrium. The clip is positioned, the leaflets grasped, and the result measured immediately — more than one clip is sometimes needed to reduce the leak adequately.

Most patients stay one to two nights. Recovery is much faster than open surgery: care for the groin site, avoid heavy lifting for about a week, and expect gradual improvement in breathing and exercise tolerance over the following weeks.

You will take antiplatelet or anticoagulant medication as directed, and follow-up echocardiograms confirm the repair is holding. Heart failure medication continues — the clip reduces the leak but does not treat the underlying ventricle, and stopping those medications would undo much of the benefit.

Tell every clinician and dentist that you have an implanted device, and ask about antibiotic prophylaxis before dental work.

Bleeding or vein injury at the groin, clip detachment or movement, injury to the valve leaflets, residual leak that remains significant, narrowing of the valve if the opening is reduced too far, stroke, and the small persistent opening in the atrial wall from the crossing. Your heart team will weigh these against how much your symptoms are limiting you and what the alternatives realistically offer.