Differences Between MitraClip and Mitral Valve Surgery

The main difference between MITRACLIP and mitral valve surgery is whether the rib cage is opened and whether the heart continues working during the procedure. In traditional open mitral valve surgery, the breastbone is opened, the heart is stopped, and the patient’s circulation is temporarily transferred to a machine. In the MitraClip method, however, the repair is performed directly on the beating heart by advancing thin tubes through the femoral vein without making an incision in the chest. This difference in the way the heart is accessed helps reduce the recovery period, which may take weeks after open surgery, to only a few days with interventional treatments. The level of physical burden placed on the patient is the most decisive factor distinguishing these two treatment options.

What Is Mitral Valve Regurgitation and How Does It Affect the Body?

The structure located on the left side of the heart that functions like a one-way door between the upper and lower chambers is called the mitral valve. When oxygenated blood arrives from the lungs and fills the upper chamber of the heart, this door opens and allows the blood to pass into the lower chamber, which is the main pump. When the heart contracts forcefully to pump blood throughout the body, this valve is expected to close tightly without leakage. If closure does not occur, some of the blood that should travel to the body flows backward toward the lungs. This condition is called mitral valve regurgitation.

Over time, this leakage gradually increases the workload of the heart. The heart must work harder to provide the blood required by the body, and this excessive effort causes the heart to become fatigued and enlarged. As the heart chambers enlarge, the structures holding the valve leaflets together move even farther apart, and the amount of leakage increases. This creates a self-perpetuating negative cycle. Blood pooling backward in the lungs creates the conditions for noticeable symptoms to develop in patients.

Common complaints associated with mitral valve regurgitation include:

  • Shortness of breath
  • Easy fatigue
  • Palpitations
  • Swelling in the legs
  • Inability to lie flat
  • Waking from sleep at night

These symptoms make it difficult for patients to perform their daily tasks and considerably reduce their quality of life. If the problem progresses, hospitalization may become unavoidable.

How Is the Treatment Process Performed with Open Mitral Valve Surgery?

For many years, the primary way to treat this leaking valve has been traditional open heart surgery. This procedure requires a comprehensive surgical intervention. Patients are placed under general anesthesia and completely put to sleep, and the rib cage is opened along the midline to reach the heart. Because the heart must be stopped during the operation, a heart-lung machine is incorporated into the system to temporarily take over the functions of the heart and lungs.

After the heart is stopped and blood flow is redirected to the machine, the diseased mitral valve is treated directly. Depending on the condition of the valve, repair is attempted using special sutures and support rings while preserving the patient’s own tissues. If the valve is too damaged or calcified to be repaired, it is completely removed and replaced with either a mechanical valve or a new valve made from biological tissues. Once the procedure is completed, the heart is restarted, the machine connections are removed, and the operation is concluded by closing the rib cage. Although this approach has been successfully used as a standard treatment for many years, it may cause considerable physical stress on the body.

In Which Situations Can Open Mitral Valve Surgery Become Difficult?

Open heart surgery can provide positive long-term results in young individuals who are in good general health and do not have other chronic diseases. However, a significant proportion of patients with mitral valve problems are in advanced age groups and may have other accompanying systemic disorders. Making a surgical decision is quite difficult in patients whose bodies are considered unable to tolerate major surgical trauma and connection to a heart-lung machine.

Conditions that may increase surgical risk include:

  • Advanced age
  • Kidney failure
  • Lung diseases
  • Weakness of the heart muscle
  • Previous stroke
  • Previous open heart surgeries

Because of such accompanying problems, some patients are considered high risk, cannot undergo surgery, and must be followed only with medication. However, because medications cannot physically correct a mechanical problem, the disease may continue to progress over time.

What Do Interventional Cardiology and the MITRACLIP Method Mean?

Advances in medical technology have led to the exploration of much less traumatic ways of intervening on the heart. Interventional cardiology is a modern field of medicine that aims to reach the inside of the heart through the blood vessels and repair various valve problems without creating large incisions in the body. Transcatheter methods developed in this context aim to protect the patient from a major surgical burden.

The MITRACLIP procedure is an interventional method that aims to reduce leakage by attaching the leaking valve leaflets to one another using a special clip. During the procedure, the rib cage is not opened, there is no need to stop the heart, and an extracorporeal circulation machine is not used. The inside of the heart is reached only through thin tubes called catheters advanced from a small vascular entry point, and internal support is provided to the impaired valve mechanism. In this way, the repair is performed without disrupting the anatomical integrity of the heart.

How Is the MITRACLIP Procedure Performed Step by Step?

The procedure generally begins with a very small entry into the large vein in the groin area. This vein functions as a direct route to the heart. The physician advances a flexible tube system called a catheter through this vein toward the upper right chamber of the heart. Because the mitral valve is located on the left side of the heart, it is necessary to pass from the right chamber to the left chamber. This passage is safely achieved by creating a millimetric opening in the thin wall between the two chambers.

The small and delicate clip located at the tip of the system is directed toward the center of the leaking mitral valve. The problematic area where the valve leaflets cannot meet and blood flows backward is identified and captured between the arms of the clip. When the arms are closed, the leaflets are attached to one another. In this way, the leaking valve, which resembles a wide central opening, is transformed into two smaller adjacent openings that function properly. Thanks to this attachment, backward blood flow is largely prevented when the heart contracts, while normal forward blood flow continues. If the condition of the valve is considered suitable, the procedure is completed by releasing the clip.

What Are the Advantages of Performing MITRACLIP Without Opening the Rib Cage?

The area where the differences are felt most strongly is the physical impact experienced by the patient during the procedure. In traditional open surgery, separation of the breastbone requires time to heal and restricts the patient’s movements for a certain period. Even simple daily actions such as lying on one side, lifting certain weights, or coughing may be difficult during this process.

Procedures performed through the blood vessels, such as MITRACLIP, offer a much gentler process. The absence of any incision in the chest and the fact that bone or muscle tissues are not damaged help preserve the patient’s physical strength. Since there is only a small needle entry in the groin area, the recovery period is quite short.

The prominent benefits for patients include:

  • No incision
  • Reduced risk of bleeding
  • Less pain
  • Rapid mobilization
  • Early return to daily life

These characteristics allow elderly or physically weakened patients to avoid long recovery periods and leave the hospital much sooner to return to their own home environment.

What Is the Difference Between MITRACLIP and Procedures Performed Without Stopping the Heart?

The most critical physiological difference between surgical and interventional methods is the condition of the heart during the procedure. In open surgery, the heart is completely stopped and emptied. After the surgeon completes the intervention, the heart is closed and restarted. The degree of success of the repair can only be understood after the heart begins beating again and returns to its natural rhythm.

In contrast, the MITRACLIP method is performed on a fully functioning heart beating in its own rhythm. Because the heart is not stopped, the organs are not deprived of their natural blood flow. The greatest medical advantage of this is that the result of the intervention on the valve can be monitored instantly. The moment the clip is attached to the leaflets, its performance under the normal contraction of the heart can be viewed live on the ultrasound screen. The extent to which the leakage has decreased is evaluated immediately. If the physician does not consider the result sufficient, the clip can be opened to release the valve, and the angle or position can be changed until the procedure reaches the most appropriate result. This immediate feedback obtained on the beating heart contributes greatly to increasing the safety and consistency of the procedure.

Which Patients May Be More Suitable for MITRACLIP Treatment?

As with every new technology, it is important to understand that this method is not a standard option for every patient. MITRACLIP is generally not considered the first choice for young and healthy individuals who can tolerate open surgery. It mainly offers an alternative for a specific group of patients in whom surgery carries a high risk or is considered technically impossible.

The feasibility of this method is particularly high in patients whose heart muscle has become fatigued, whose contraction strength has decreased, and whose heart has enlarged and disrupted the structure of the valve.

General characteristics supporting suitability for MITRACLIP include:

  • High surgical risk
  • Weakened heart muscle
  • Advanced age
  • Serious accompanying diseases
  • Anatomical suitability

In patients with these characteristics, the primary objective is to eliminate the dangers created by a long and difficult surgical process and relieve the mechanical problem of the valve with the least possible harm. In this way, the patient’s comfort and quality of life may be improved.

Can Medication Replace Mitral Valve Surgery or MITRACLIP?

Modern medications are vitally important in the management of heart failure and valve diseases. Medications that regulate the patient’s blood pressure, stabilize the rhythm, and eliminate excess fluid accumulated in the body through the kidneys provide significant relief. However, medication and physical interventions on the valve are not alternatives to one another but complementary treatments.

To explain the situation with an analogy, imagine that there is a large hole in the roof of your house and water enters every time it rains. Medication is similar to collecting the water in buckets and carrying it outside. As long as the water is removed, it is possible to live in the house and the complaints decrease. However, as long as the hole in the roof remains, the same problem will continue every time it rains. Structural procedures such as open heart surgery or MITRACLIP aim to physically repair that hole in the roof. Repairing the valve reduces the burden on medications, gives the heart time to recover, and helps break the cycle of repeated emergency department visits. Therefore, it is unfortunately not possible to correct a structurally damaged valve with medication alone.

What Do Scientific Studies Say About the MITRACLIP Method?

The widespread acceptance of a treatment method in the medical world depends on the results of scientific studies conducted over many years and involving large numbers of patients. The MITRACLIP method has also been the subject of many large-scale studies, and its effectiveness has been examined from various perspectives.

Large studies conducted particularly on mitral regurgitation caused by weakening of the heart muscle have demonstrated the changes this device can create in patients’ lives. Current studies comparing patients receiving only the best medical treatment with patients receiving MITRACLIP in addition to medication have produced very clear data. In the group treated with the clipping method, a marked reduction was observed in hospital admission rates caused by shortness of breath or cardiac fatigue. Positive results were also obtained, including increased walking distances, greater ease in performing daily activities, and higher scores on general quality-of-life questionnaires. Provided that the correct patients are selected, the scientific community also recognizes that this method can positively alter the course of the disease.

Why Is Echocardiography Very Important Before MITRACLIP?

In interventional cardiology, because the physician does not open the rib cage, the valve cannot be seen directly with the eyes or touched with the hands. In this situation, echocardiography, an advanced ultrasound technology, serves as the eyes and ears of the procedure. With the help of a thin probe passed through the esophagus, known as Transesophageal Echocardiography, high-resolution images of the valve are obtained from the rear side of the heart.

This evaluation performed before the procedure is highly critical for determining whether the anatomy of the valve is suitable for clip placement.

The parameters evaluated with echocardiography include:

  • Distance between the valve leaflets
  • Location of the leakage
  • Degree of calcification
  • Width of the valve
  • Thickness of the valve tissue

During the procedure, the inside of the heart is also mapped three-dimensionally using the same device, and the physician guides the catheter by observing these images. Coordinated work between the imaging specialist and the cardiologist performing the procedure is one of the most important factors in ensuring that the process proceeds smoothly. Thanks to advancing device designs, it is now possible to intervene on more challenging valves with wider gaps.

What Can Be Done for Patients Who Have Previously Undergone Mitral Valve Surgery?

Another problem encountered by patients who previously underwent open heart surgery and had their mitral valve replaced with a biological prosthetic valve made from animal tissues is that these valves may calcify, degenerate, and lose their function over time. When these valves deteriorate within an average of ten to fifteen years, the patient may need another operation. Opening the rib cage for a second or third time creates a highly risky situation because of internal adhesions and the patient’s advanced age.

At this stage, transcatheter valve replacement methods are used. Just as in the clip procedure, a system advanced through the femoral vessel delivers a folded new valve directly inside the previously implanted and deteriorated valve. The new valve opens like an umbrella within the frame of the old valve, takes over its function within seconds, and regulates blood flow.

The methods used in such situations include:

  • Valve-in-valve
  • Valve-in-ring
  • Valve-in-calcification

In this way, patients are protected from a second open heart operation that may carry much higher life-threatening risks. These procedures performed through the same access points are also among the greatest conveniences offered to patients by modern medicine.

What Are the Recovery Processes After MITRACLIP and Mitral Valve Surgery?

There are considerable differences between the two methods in terms of the length of hospital stay and the time required to return to normal life. The recovery process of a patient undergoing open heart surgery may generally involve several days in intensive care followed by ward monitoring, with the total hospital stay reaching approximately one week. After returning home, six to eight weeks are required for the breastbone to heal. During this period, the patient is expected to sleep on the back, avoid lifting heavy objects, and refrain from certain physical movements.

The process after the MITRACLIP procedure progresses very differently. The procedure is generally completed within one to three hours. Patients are transferred to their rooms while awake or under the effect of mild sedation and are usually monitored closely during the first night as a precaution. Since there is no wound in the chest area, respiratory movements are not restricted, and severe pain is not felt when taking a deep breath. Many patients may notice a reduction in procedure-related shortness of breath within the early hours.

The characteristics of the recovery period after MITRACLIP include:

  • Short hospital stay
  • Rapid mobilization
  • Early return to daily life
  • No need for wound care

Patients can generally be discharged home on the second or third day in a condition that allows them to meet their own needs. Such a short recovery period greatly helps elderly patients leave the hospital environment quickly and also feel psychologically relieved.

What Is the Role of the Heart Team in Deciding Between MITRACLIP and Mitral Valve Surgery?

The availability of numerous technological options for treating mitral valve problems has made the process of selecting the most appropriate decision for patients even more important. Current medical guidelines recommend that such critical decisions be made not by a single physician but by a council bringing together different medical specialties. This council, called the “Heart Team,” evaluates the patient using a comprehensive approach.

Cardiovascular surgeons, interventional cardiologists, imaging specialists, and anesthesiologists come together in this team and examine the patient’s medical file in detail. Many parameters, including the patient’s age, lung condition, kidney functions, heart muscle structure, and overall physical resilience, are evaluated. If the surgical risk is low and the structure of the valve is more suitable for surgical repair, open surgery may be prioritized. However, if the patient is considered surgically fragile, the potential benefits of transcatheter methods are discussed, and the most appropriate interventional roadmap is determined.

These advances in medicine offer patients much gentler, more comfortable, and safer options than in the past. Many patients who previously had to be left without an effective solution can now breathe comfortably again through procedures performed through the blood vessels. Having patients diagnosed with mitral valve regurgitation evaluated by specialized councils and interventional cardiology units before making a treatment decision allows them to take the most appropriate step for their bodies. Science and medical practice continue to improve quality of life with increasingly compassionate approaches every day.

Frequently Asked Questions

MitraClip is a minimally invasive method performed through a catheter inserted from the groin and does not require open heart surgery. Mitral valve surgery involves surgical repair or replacement of the valve. The treatment choice is planned individually for each patient.

Hospital stay and the time required to return to daily life are generally shorter after MitraClip. In surgical mitral valve procedures, the recovery period may be longer because the breastbone needs time to heal.

MitraClip is a treatment option particularly considered for patients with severe mitral valve regurgitation who are elderly, have a high risk for open heart surgery, and possess suitable anatomical characteristics.

Surgical valve repair or replacement may be preferred if there is advanced structural valve disease, severe calcification, irreparable damage, or anatomical characteristics unsuitable for MitraClip.

Treatment success may vary according to the severity of mitral valve regurgitation, valve anatomy, the heart’s pumping strength, the patient’s age, accompanying diseases, and whether the procedure is performed in an experienced center.

The blood-thinning and other medications used after the procedure are determined according to the patient’s rhythm disorder, valve disease, and additional health problems. Medications should only be used as recommended by the cardiologist.

After both treatments, the function of the mitral valve is evaluated through echocardiography and cardiology checkups. Regular follow-up helps detect possible complications early and monitor treatment success.

Most patients can stand shortly after the procedure and return to daily activities within a few days. The timing of returning to physical activity should be planned according to the patient’s clinical condition and the physician’s recommendations.

After successful treatment, complaints such as shortness of breath, easy fatigue, and exercise limitation may decrease significantly. As a result, many patients may experience improved daily quality of life and physical capacity.

The treatment decision is made by a heart team consisting of cardiology and cardiac surgery specialists after jointly evaluating the valve structure, severity of mitral regurgitation, the patient’s age, surgical risk, and accompanying diseases.

Güncellenme Tarihi: 20.07.2026

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