A year ago, a 92-year-old woman began experiencing breathlessness during simple day-to-day activities. What seemed at first to be a manageable problem slowly deteriorated over time until it reached a point where even normal movement was tiring. Following recent hospitalization for heart failure, further assessment showed that the patient had severe ischemic Mitral Regurgitation (MR), where the heart’s mitral valve does not close properly and blood leaks backward into the heart.
She had a history of angioplasty, underlying lung disease, poor heart function, and was significantly frail, making her a high-risk candidate for conventional open-heart surgery. She reached the hospital when her condition had worsened to NYHA Class IV symptoms, severely affecting her quality of life and restricting her ability to perform even the most basic activities independently.
Complex Case Required Innovative Approach
Explaining the complexity of the case, Dr. M Sudhakar Rao, Consultant – Cardiology, Manipal Hospital, Sarjapur Road, stated, “At 92 years of age, with severe frailty and multiple comorbidities, conventional surgery carried a very high risk for the patient. MTEER allowed us to treat her severe mitral regurgitation through a minimally invasive approach, while ensuring faster recovery and significant symptomatic improvement.”
After a comprehensive evaluation, the multidisciplinary heart team decided against surgical mitral valve replacement due to the extremely high operative risk. Instead, the team planned a minimally invasive Transcatheter Mitral Edge-to-Edge Repair (MTEER), commonly known as MitraClip.
Procedure and Recovery
The procedure was performed through transfemoral access via the groin using a transseptal puncture technique to access the left side of the heart. Using advanced imaging guidance, the mitral valve was successfully repaired with the MitraClip device, significantly reducing the valve leakage from severe to mild. The minimally invasive procedure was completed in nearly two hours, with the patient requiring only a three-day hospital stay.
Speaking about the patient’s recovery, Dr. Sudhakar said, “The most encouraging part of this case was seeing the patient regain her mobility and confidence within days of the procedure. For patients with advanced heart failure symptoms, even small improvements in functional capacity can make a meaningful difference to their quality of life.”
The patient had an excellent recovery within a week of intervention and could walk comfortably for 20-25 minutes without breathlessness or fatigue. Highlighting the significance of such interventions in high-risk patients, Dr. Sudhakar added, “Cases like these highlight how structural heart interventions are changing the way we manage high-risk cardiac patients. With careful planning, imaging guidance, and a multidisciplinary team approach, minimally invasive procedures such as MTEER can offer excellent outcomes even in very elderly patients.”
