Recommendation for NHSScotland

MitraClip® transcatheter mitral valve repair should be considered for patients with moderate-to-severe (grade 3+) or severe (grade 4+) mitral regurgitation who are not eligible for open mitral valve repair surgery. Decisions should be made by a multi-disciplinary team with experience of performing this procedure, taking into account individual patients’ level of risk, comorbidities, preferences and quality of life.

The annual procedure volume per centre for MitraClip® should be maximised to support optimal patient outcomes and ensure clinical experience with this complex procedure is achieved and retained.

NHSScotland is required to consider the Scottish Health Technologies Group (SHTG) advice.

What were we asked to look at?

We were asked to provide advice on the use of MitraClip® mitral valve repair system in patients with moderate-to-severe or severe mitral regurgitation who are at high surgical risk or inoperable.

Why is this important?

Left untreated, moderate or severe mitral regurgitation can lead to heart failure, serious cardiac arrhythmias and death. The symptoms of chronic mitral regurgitation and associated heart failure confer a substantial physical, emotional and social burden on patients. Severe symptoms may prevent patients from performing everyday tasks and simple activities, such as climbing a set of stairs. Current treatments for severe mitral regurgitation include medical management and surgical repair or replacement of the mitral valve. However some patients are at such high surgical risk that they cannot undergo traditional surgical repair or replacement of the mitral valve. The MitraClip®. System offers a transcatheter approach to repairing the mitral valve, thereby avoiding the risks
associated with open heart surgery and cardiopulmonary bypass.

Referred by

The National Advisory Committee on Heart Disease