Names & Terms You Will Hear
Plain-language meanings for the terms your care team may use.
| Term | Meaning |
|---|---|
| TEER | Transcatheter edge-to-edge repair. A catheter clips your leaky valve. No chest cut needed. |
| MitraClip | Abbott's clip device. The most-used TEER system. Two sizes: NTR and XTR. |
| PASCAL | Edwards Lifesciences clip device. The second FDA-approved TEER option. |
| Mitral regurgitation (MR) | A leaky mitral valve. Blood flows backward. Graded mild, moderate, or severe. |
| Primary MR | The valve itself is broken. Causes: floppy leaflet, torn cord, or infection. |
| Secondary MR | The valve is normal. A weak, stretched heart pulls it open. |
| Double-orifice valve | The result after TEER. The clip joins the leaflets. This creates two small openings instead of one big leak. |
| Transseptal puncture | Crossing the wall between the two upper heart chambers. This is how the catheter reaches the valve. |
| TEE | A small camera placed in your throat. It guides the clip with live pictures. |
| GDMT | Your full set of heart-failure medicines. These are taken before any procedure is tried. |
| Heart Team | Your cardiologist, heart surgeon, and imaging doctor. They review your case together before any decision. |
Two devices — same idea: Abbott MitraClip G4 (NTR and XTR clip sizes; most data) and Edwards PASCAL (broader clasper). Both are FDA-approved for TEER. Your Heart Team picks based on your valve anatomy. Both create a double-orifice valve — one clip, two openings, less leak.
What Is MitraClip / TEER?
- TEER stands for transcatheter edge-to-edge repair. It clips your two mitral valve leaflets together. This stops the backward leak without opening your chest.
- A thin tube enters a vein in your groin. No chest cut is needed.
- The tube crosses the wall between the upper heart chambers. It reaches the valve from above. Live echo images guide every move.
- MitraClip (Abbott G4) is the most-used device. Edwards PASCAL is the second FDA-approved option. Both work the same way.
- The procedure takes 1 to 3 hours. You sleep under general anesthesia in a cath lab.
- Most patients go home in 1 to 2 days. No chest cut. No heart-lung machine.
Why It Matters
- A severe leak forces your heart to pump extra blood each beat. Over time, this weakens the heart muscle.
- Untreated severe MR can cause heart failure, atrial fibrillation, and high lung pressure. These can shorten your life. This can happen before you feel very sick.
- TEER fixes the valve without open-heart surgery. It is a much lower-risk option for patients who cannot safely have surgery.
- The COAPT trial tested TEER in secondary MR. TEER cut heart-failure hospital stays by 47% at 2 years. It also reduced death at 2 years.
- Most patients feel less short of breath within weeks. They can do more without getting tired.
Risk Factors
Knowing your personal risks helps your care team take extra precautions.
| Risk Factor | Why It Increases Risk |
|---|---|
| Mitral valve prolapse (MVP) | Most common cause of primary MR. A floppy leaflet can break a cord over time. |
| Prior heart attack | Damage to heart muscle can pull the leaflets apart. This causes secondary MR. |
| Dilated cardiomyopathy / heart failure | A stretched, weak heart pulls the valve open. |
| Older age | Wear and tear on valve cords is more common after age 60. |
| Connective tissue disease | Marfan or Ehlers-Danlos syndrome. Cord and leaflet tissue is weaker. |
| Rheumatic heart disease | Old strep infection scars the valve. Still common in many countries. |
| Prior valve infection (endocarditis) | Infection can destroy a leaflet. This can cause sudden, severe MR. |
Primary (Degenerative) MR — Who Benefits from TEER
- Primary MR is caused by a broken valve. Causes include mitral valve prolapse (MVP), torn cords, endocarditis, and rheumatic scarring.
- Surgical repair is the gold standard. It preserves your own valve. Repair is possible in more than 80% of degenerative MR cases at expert centers.
- TEER is an option (ACC/AHA Class IIa) for severe primary MR when surgery is too risky. Your doctor calls this high or prohibitive surgical risk.
- The EVEREST II trial compared MitraClip to surgery. MitraClip was safer. Surgery removed more MR. Long-term, patients with a lasting benefit from TEER did well.
- Two devices are approved: Abbott MitraClip G4 (NTR and XTR clip sizes) and Edwards PASCAL (broader clasper, different grasp mechanism).
- Heart Team review is required before choosing TEER over surgery for primary MR.
Secondary (Functional) MR — COAPT vs MITRA-FR: Why Selection Matters
- In secondary MR, the valve leaflets are normal. A weak or dilated LV pulls them apart. The problem is the sick heart, not the valve.
- Step 1 is always GDMT: ACEi or ARNI plus beta-blocker, MRA, and SGLT2 inhibitor for 3 to 6 months. Many leaks shrink with medicines alone.
- COAPT trial (NEJM 2018, positive): Used strict patient criteria (ERO 0.20 cm² or higher, EF 20–50%). At 2 years: HF stays were 35.8% with TEER vs 67.9% with medicines. Death was 29.1% vs 46.1%. Benefits lasted at 3 years.
- MITRA-FR trial (NEJM 2018, neutral): Enrolled patients with larger, more dilated hearts. The leak was smaller relative to LV size. The primary endpoint was neutral. The LV was too dilated for TEER to help.
- The key lesson: disproportionate MR (leak too big for the LV size) benefits from TEER. Proportionate MR (LV very dilated, leak fits the size) does not benefit as reliably.
- ACC/AHA 2020 criteria for TEER in secondary MR: ERO 0.20 cm² or higher, coaptation depth 11 mm or less, coaptation length 2 mm or more, and anatomy suited for clip grasping.
Treatment Options
Shown in English for your safety — this section is not automatically translated. Confirm with your doctor or call the office.
- Step 1 for secondary MR: take your heart-failure medicines first. This means beta-blocker, ARNI or ACEi, MRA, and SGLT2 inhibitor for 3 to 6 months. The leak often shrinks with medicines alone.
- TEER / MitraClip clips the valve from the inside. No open surgery is needed. It works best for primary MR when surgery is too risky. It also works for secondary MR that stays severe after full medicine treatment.
- Surgical repair is the best option for patients who can safely have surgery. Repair keeps your own valve. It lasts for decades.
- Surgical valve replacement is used when repair is not possible. A tissue valve needs no blood thinner. A metal valve needs a blood thinner every day for life.
- Watch and wait with yearly echo is for mild or moderate MR with no symptoms. Your doctor tracks your heart size and valve grade each year.
- Heart Team review is required. A cardiologist, heart surgeon, and imaging doctor meet. They choose the best plan for you.
The TEER Procedure — What Happens in the Cath Lab
- Preparation: Nothing to eat or drink after midnight. General anesthesia is standard. TEE requires a throat probe. Some centers use deep sedation.
- Access: A needle enters the femoral vein in the groin. A wire and sheath are advanced to the right atrium.
- Transseptal puncture: The catheter crosses the atrial wall into the left atrium. TEE and X-ray guide the safe crossing point.
- Clip delivery: The clip system is steered down through the mitral valve. The cardiologist opens the clip arms. The clip grasps both leaflets from below and closes.
- Echo check: TEE confirms the leak is reduced to mild or trace. If not, the clip is moved or a second clip is added.
- Closure: The catheter is removed. The groin site is closed with pressure or a plug. Most patients walk within a few hours.
- Monitoring: You stay 1 to 2 nights. An echo is done before you go home. A 30-day echo and clinic visit follow.
Risks, Benefits, and Alternatives
Shown in English for your safety — this section is not automatically translated. Confirm with your doctor or call the office.
Every choice has trade-offs. Use this table to start the shared decision conversation with your care team.
| Option | Risks | Benefits | Alternatives |
|---|---|---|---|
| TEER (MitraClip / PASCAL) | Leak may stay or return (10–20% at 1 year). Clip may miss one leaflet (~1%). Valve may narrow after clipping (<2%). Groin bleeding 1–2%. Stroke ~1%. | No chest cut. No heart-lung machine. Home in 1–2 days. Death risk ~2%. COAPT: 47% fewer HF stays. Survival benefit at 2 years. | Repair for healthy patients. Medicines first for secondary MR. |
| Surgical valve repair (best for primary MR) | Open-heart surgery. Stroke 1–2%. Blood transfusion possible. New AFib ~30%. Recovery 6–8 weeks. | Lasts decades. Uses your own valve. No implant needed. Best long-term result for operable patients. | TEER if surgery is too risky. Replacement if repair is not possible. |
| Surgical valve replacement | Same surgery risks. Metal valve: blood thinner for life. Tissue valve: lasts 10–15 years; may need re-op. | Used when repair is not possible. Stops the leak reliably. | Repair if possible. Valve-in-valve TEER if tissue valve wears out later. |
| Heart-failure medicines (GDMT — secondary MR only) | Can lower blood pressure or change kidney function. Leak may not improve enough. | Can shrink the leak by 30–50%. Must try first before any procedure. | Add TEER if leak stays severe after 3–6 months of medicines. |
TEER vs Surgery — Head-to-Head Comparison
| Feature | TEER (MitraClip / PASCAL) | Surgical Repair / Replacement |
|---|---|---|
| Access | Vein in groin. No chest cut. | Open chest. Sternotomy or mini-thoracotomy. |
| Heart-lung machine | Not used | Used for surgery |
| Anesthesia | General (TEE-guided) | General anesthesia |
| Hospital stay | 1–2 nights | 5–7 nights |
| Recovery | Days to 2 weeks | 6–8 weeks |
| In-hospital mortality | ~2% (TVT Registry) | 1–3% (elective repair) |
| Stroke risk | ~1% | 1–2% |
| MR reduction | Good: to mild in >90% | Excellent: to none in >95% |
| Durability | 10-yr data growing. ~10–20% re-intervention. | Decades (repair). 10–15 yr (tissue valve). |
| Best for | High-risk primary MR. COAPT-like secondary MR. | Operable primary MR. Complex anatomy. |
Common Misconceptions
| Myth | Reality |
|---|---|
| MitraClip replaces the mitral valve. | No. The clip grabs your own leaflets and holds them together. Your valve stays in place. Nothing is removed. |
| TEER cures heart failure. | TEER reduces the leak. In the right patients, it cuts hospital stays. It also helps people live longer. But it does not fix the heart muscle. Keep taking your heart-failure medicines. |
| Some MR left after MitraClip means it failed. | A small remaining leak is normal and okay. The goal is to reduce the leak to mild, not zero. The COAPT trial showed big benefits even with some MR remaining. |
| MITRA-FR proved MitraClip does not work. | MITRA-FR enrolled patients with very dilated hearts and smaller leaks. COAPT enrolled patients with a bigger leak for their heart size. COAPT showed a clear win. Patient selection is the key. |
| All patients with MR should get MitraClip. | TEER is for specific patients. Younger, healthy patients with primary MR do better with surgery. TEER is best for high-risk patients or those with secondary MR on full medicines. |
| My heart has to stop for MitraClip. | Your heart keeps beating the whole time. No heart-lung machine is used. This is a key advantage over open surgery. |
| MitraClip is a quick clinic visit. | TEER requires general anesthesia. You stay 1 to 2 nights for monitoring. It is done in a full cath lab, not a clinic room. |
After TEER — what to remember:
• Take aspirin (or your prescribed antiplatelet) every day.
• Keep taking your heart-failure medicines. TEER does not replace them.
• Tell all providers — especially your dentist — about your procedure.
• Get a 30-day and 1-year echo. Call if shortness of breath returns.
• Take aspirin (or your prescribed antiplatelet) every day.
• Keep taking your heart-failure medicines. TEER does not replace them.
• Tell all providers — especially your dentist — about your procedure.
• Get a 30-day and 1-year echo. Call if shortness of breath returns.
Possible Complications
Knowing what can go wrong helps you spot problems early. Most complications are uncommon, especially with treatment.
| Where / What | What Can Happen |
|---|---|
| Single-leaflet attachment | Clip grabs one leaflet but not both. Needs a repeat clip or urgent surgery. Occurs in about 1% of cases. |
| Residual or recurrent MR | Leak may not improve enough. It may also return over time. About 10 to 20% need a repeat procedure within 2 years. |
| Valve too narrow after clip | A very tight clip can slow blood flow across the valve. This is rare — under 2% with careful sizing. |
| Stroke or mini-stroke | A small clot or air bubble can travel during the procedure. About 1% of cases. Treated with blood thinners. |
| Groin bleeding | Bruising or swelling at the entry site. Artery injury is rare. Major bleeding occurs in 1 to 2%. |
| Cardiac tamponade | A small hole can form in the heart wall during catheter crossing. Under 0.5%. Treated right away. |
| Atrial fibrillation | New or worse AFib may appear after the procedure. This raises stroke risk. Managed with medicines. |
| Clip moves out of place | Very rare — under 0.1%. The clip shifts and must be retrieved. |
Points to Know
Shown in English for your safety — this section is not automatically translated. Confirm with your doctor or call the office.
If you remember nothing else, remember these key points.
- TEER (MitraClip or PASCAL) clips your mitral leaflets together. No chest cut. No heart-lung machine.
- There are two types of MR. Primary MR means the valve is broken. Secondary MR means the heart is weak and pulls the valve open. The treatments differ.
- For secondary MR, your doctor tries full heart-failure medicines for 3 to 6 months first. The MITRA-FR trial showed that skipping this step leads to no benefit from TEER.
- The COAPT trial showed TEER cut heart-failure hospital stays by nearly half. It also improved 2-year survival in the right patients.
- Your Heart Team includes a cardiologist, surgeon, and imaging doctor. They review your case and pick the best plan.
- Most patients go home in 1 to 2 days. Shortness of breath improves within weeks. Yearly echo check-ups are needed.
- After TEER, tell your dentist and other doctors about your procedure. You may need an antibiotic before dental work.
When to Call Us — and When to Call 911
Shown in English for your safety — this section is not automatically translated. Confirm with your doctor or call the office.
If you are not sure, call. We would rather hear from you twice than miss a real problem.
- Call 911 for sudden severe shortness of breath, especially lying flat.
- Call 911 for stroke signs: face droop, arm weakness, or slurred speech.
- Call 911 for chest pain or fainting.
- Call our office if the groin site bleeds through your bandage or swells a lot.
- Call our office for fever above 100.4°F more than 2 days after the procedure.
- Call our office for a new fast or irregular heartbeat.
- Call our office if shortness of breath comes back after it was getting better.
- Call our office if your weight goes up 3 or more pounds in a day or two, or your ankles swell.
- Call our office before any dental or surgical procedure to ask about antibiotics.
Office: (727) 943-5200
Trusted Resources
Independent, evidence-based pages we recommend for deeper reading.
- ACC CardioSmart — Mitral Valve Regurgitation — Plain-language ACC patient guide for MR and TEER.
- AHA — Heart Valve Problems — American Heart Association overview of valve disease.
- Mayo Clinic — MitraClip Procedure — Who qualifies, how it works, and what to expect.
- Cleveland Clinic — TEER (MitraClip) — Procedure details, risks, and recovery.
- Dr. Ali — Mitral Regurgitation Guide — Companion guide on MR types, grading, and all treatments.
- Society of Thoracic Surgeons — Patient Resources — Patient guide for mitral surgery and risk calculators.
Sources Used to Build This Guide
- Stone GW et al. — COAPT Trial (NEJM 2018) [clinical_trial] — COAPT: MitraClip vs medical therapy in secondary MR (HF with EF 20–50%, ERO ≥ 0.20 cm², strict anatomic criteria). At 2 years: 35.8% vs 67.9% HF hospitalization rate (p<0.001); all-cause mortality 29.1% vs 46.1%.
- Obadia J-F et al. — MITRA-FR Trial (NEJM 2018) [clinical_trial] — MITRA-FR: MitraClip vs medical therapy in secondary MR — neutral result. Key difference: less anatomic selection (ERO 0.20–0.39 cm² but larger LV); supports GDMT-first and anatomy-nuanced patient selection.
- Feldman T et al. — EVEREST II Trial (NEJM 2011) [clinical_trial] — EVEREST II: MitraClip vs mitral surgery for primary and secondary MR in patients with surgical risk. MitraClip superior for safety; surgery more effective MR reduction at 12 months; underpins high-surgical-risk indication.
- 2020 ACC/AHA Guideline for Valvular Heart Disease [guideline] — Current ACC/AHA Class IIa recommendation for TEER in symptomatic severe primary MR at high/prohibitive surgical risk; Class IIa for carefully selected secondary MR (COAPT-like anatomy) on maximized GDMT.
- ACC CardioSmart — Mitral Valve Regurgitation (Patient Resource) [patient_resource] — ACC CardioSmart patient-facing material for MR, providing plain-language framing for symptoms, diagnosis, and treatment.
- American Heart Association — Heart Valve Problems [patient_resource] — AHA patient-facing overview of valve disease, treatment options, and recovery.
- Mayo Clinic — MitraClip Procedure [patient_resource] — Mayo Clinic plain-language description of MitraClip: who it helps, how it works, and what recovery involves.
- Cleveland Clinic — Transcatheter Edge-to-Edge Repair (TEER) [patient_resource] — Cleveland Clinic TEER page covering procedure details, candidacy criteria, and risks in accessible language.
- Abbott MitraClip G4 System — Device Reference [device_reference] — Primary device reference for MitraClip G4 system (NTR + XTR clip sizes), used to accurately describe the clip delivery system and double-orifice mechanism.
- Edwards PASCAL TEER System — Device Reference [device_reference] — Reference for Edwards PASCAL transcatheter edge-to-edge repair system, the second FDA-approved TEER device.
- STS/ACC TVT Registry — MitraClip Procedural Outcomes [registry] — National TVT Registry source for real-world TEER procedural outcomes: in-hospital mortality ~2%, stroke ~1%, single-leaflet device detachment ~1%, 30-day MR reduction to mild/none in >90%.
- Mack MJ et al. — COAPT 3-Year Follow-Up (Circulation 2021) [clinical_trial] — COAPT 3-year outcomes: durable mortality benefit and HF hospitalization reduction sustained in TEER vs medical therapy arm for secondary MR.
