The National Heart Centre Singapore (NHCS) successfully performed Asia’s first minimally invasive heart valve repair using the MitraClip system, on a 68-year-old female patient on 14 April 2011. This new treatment is targeted at high-risk patients with severe mitral regurgitation, a condition in which your heart's mitral valve doesn't close tightly, allowing blood to flow backwards into your heart. Left untreated, up to 30 per cent of these patients with severe regurgitation may die within six years. It may also lead to irregular heartbeat and worsening congestive heart failure. In those with pre-existing heart failure, up to 60 per cent may die in five years.

The efficacy and safety of this new minimally invasive heart valve repair was studied in the EVEREST II clinical trial which compared the minimally invasive approach with the open surgery method in 279 patients. The findings showed that the minimally invasive approach was much safer with 33 per cent fewer major adverse events at 30 days. Both groups of patients experienced improvement in heart function and reduction in symptoms. In terms of clinical success rate, the minimally invasive group saw 55 per cent compared to 73 per cent for the surgery group at one year after treatment. At two years, the success rate was 52 per cent for the minimally invasive group compared to 66 per cent for the surgery group. Sharing on the importance of this new procedure, Dr Yeo Khung Keong, Consultant, Department of Cardiology, NHCS and the lead physician for the MitraClip procedure said, “The key advantages of the MitraClip® procedure are improved safety, shorter hospital stay and recovery time and less risk of complications. The introduction of this new percutaneous valve repair provides a viable treatment for severe mitral regurgitation patients who are at high surgical risk.” 

Currently, patients with severe mitral regurgitation are treated with medications or surgery. However medications can only relieve the symptoms. The surgery option may not be suitable for those who are too weak to undergo an open heart surgery or who have other medical conditions such as severe lung disease or prior open heart surgery.

Mdm Margaret Lim, 68, was the first patient in Asia to undergo the minimally invasive procedure on 14 April 2011 at NHCS. Mdm Lim had severe mitral regurgitation complicated by congestive heart failure resulting in lung congestion. She was not suitable for the open surgery method because of her severely weakened heart, lung problems and previous open heart surgery. Sharing her experience, Mdm Lim said, “I don’t feel any pain after the procedure. Last time, I was always tired and breathless. Now, I feel more energetic and can do the household chores and go out with my friends”.

NHCS has performed four cases to date. All patients have reported improvements in symptoms and are doing well. The procedure takes an average of three hours and involves a multi-disciplinary team comprising interventional cardiologists,  echocardiologists, cardiothoracic surgeons, anaesthetists, nursing and paramedical staff. The new procedure is performed through a small incision in the groin approximately 1cm in length. A 4-mm-wide metallic clip is delivered through this incision to the heart where the leaky valve is clipped in the middle, reducing the amount of regurgitation. “Mitral regurgitation affects about 12 per cent of those aged 75 years old and above. As one in five Singaporeans will be 65 and older by 2030, this group of patients is set to rise. We estimate up to 50 patients a year may benefit from this new therapy,” said Associate Professor Koh Tian Hai, Medical Director, NHCS.