TEER / MitraClip
for Mitral Regurgitation
A minimally invasive, catheter-based treatment for selected patients with a leaking mitral valve. TEER reduces mitral regurgitation without opening the chest.
TEER is not suitable for every patient. Treatment depends on the cause and severity of mitral regurgitation, valve anatomy, overall health and surgical risk. An individualised assessment is required.
What is TEER / MitraClip?
Transcatheter Edge-to-Edge Repair — also known by the device name MitraClip
In mitral regurgitation, the mitral valve does not close properly, allowing blood to flow backwards into the left atrium with each heartbeat. This forces the heart to work harder and can cause breathlessness, fatigue and declining exercise capacity.
TEER uses a specialised clip delivered through a catheter to bring the mitral valve leaflets closer together, reducing the backward flow of blood. The procedure is performed under echocardiographic and X-ray imaging guidance — without a standard sternotomy.
- TEER is distinct from TAVI — it treats the mitral valve, not the aortic valve
- Catheter-based delivery, usually through a vein in the groin
- Aims to reduce the degree of mitral regurgitation
- Detailed 3D echocardiography is central to the procedure
- No standard sternotomy — no heart-lung machine routinely required
Dr Ankur Phatarpekar explains TEER, mitral regurgitation and how the Heart Team determines whether this approach is appropriate.
Common symptoms of mitral regurgitation
Mitral regurgitation can develop gradually. Some people have few or no symptoms initially, while others develop symptoms as the condition progresses. A medical evaluation is needed to confirm whether symptoms are related to valve disease.
Who may be considered for TEER?
TEER is not simply an alternative that replaces surgery for everyone with mitral valve disease. Suitability is determined by a detailed clinical and imaging assessment.
The presence of mitral regurgitation does not automatically mean TEER is required. The Heart Team reviews each case — including TEER, surgery and medical management — before any recommendation is made.
How TEER is performed
The procedure is carried out in a specialised cardiac catheterisation environment. 3D transoesophageal echocardiography plays a central role throughout.
TEER or mitral valve surgery?
The choice between TEER and surgery depends on the type of mitral valve disease, anatomy, symptoms, heart function, age, overall health and surgical risk. One approach is not universally better than the other.
| TEER (MitraClip) | Mitral Valve Surgery | |
|---|---|---|
| Approach | Catheter-based procedure | Surgical procedure |
| Access | Catheter, usually through a vein in the groin | Surgical access through the chest |
| Chest opening | No standard sternotomy | Usually required |
| Heart-lung machine | Not routinely required | May be required |
| Suitability | Selected patients with suitable anatomy and clinical indication | Appropriate patients where surgery is the preferred treatment |
| Decision | Multidisciplinary Heart Team assessment | Multidisciplinary Heart Team assessment |
The important question is not "which procedure is better?" — it is "which treatment is most appropriate for this particular patient?" A Heart Team can review your clinical condition and imaging to help determine the most suitable pathway.
What does the clinical evidence show?
The COAPT randomised trial assessed TEER with MitraClip in a specific population of patients with heart failure and significant secondary mitral regurgitation despite guideline-directed medical therapy.
These figures apply to the specific COAPT study population and should not be interpreted as any individual patient's expected outcome. Results vary depending on the cause of mitral regurgitation, anatomy, heart function and other clinical factors.
Source: Stone GW, et al. Transcatheter Mitral-Valve Repair in Patients with Heart Failure. New England Journal of Medicine. 2018;379:2307–2318 (COAPT Trial). Additional reference: ACC/AHA Guideline for the Management of Patients with Valvular Heart Disease.
Your Heart Team
Dr Ankur Phatarpekar is an interventional cardiologist with expertise in complex coronary and structural heart interventions, including transcatheter valve procedures. At The Valve Clinic, he works with a multidisciplinary team to evaluate patients with heart valve disease and determine the most appropriate treatment pathway.
- Detailed clinical assessment
- Advanced cardiac imaging
- Multidisciplinary Heart Team review
- Individualised treatment planning
- Minimally invasive treatment where appropriate
- Follow-up after the procedure
TEER requires more than the person delivering the device. At The Valve Clinic, relevant specialists work together — including interventional cardiologists, echocardiographers, cardiac surgeons and anaesthesiologists — to ensure your case is assessed from every angle before any recommendation is made.
Frequently asked questions
TEER (Transcatheter Edge-to-Edge Repair) is the category of procedure. MitraClip is a device used for this type of repair. The terms are sometimes used interchangeably. Other devices in this category also exist. TEER treats the mitral valve and is distinct from TAVI, which treats the aortic valve.
Suitability depends on several factors, including the cause and severity of mitral regurgitation, symptoms, valve anatomy, heart function, overall health and surgical risk. A detailed clinical and imaging assessment — including echocardiography — is required before any recommendation is made.
It is not appropriate to describe TEER as universally safer than surgery. Both procedures have potential benefits and risks. TEER may be particularly appropriate for selected patients who face high or prohibitive surgical risk. The Heart Team assesses the relative risks and benefits for each individual.
The objective of TEER is to reduce mitral regurgitation, but the degree of reduction varies between patients. The final result depends on valve anatomy, the mechanism of the disease and how the heart responds to treatment. The team will discuss expected outcomes during the assessment process.
Assessment may include an echocardiogram, transoesophageal echocardiography and other imaging or investigations depending on the patient's condition. Detailed echocardiography is particularly important in determining whether the mitral valve anatomy is suitable for TEER.
The cost varies depending on the device used, hospital, procedural requirements and the patient's clinical condition. A personalised estimate can be provided after the patient's clinical information and reports have been reviewed by our team. Please contact us to discuss your specific situation.