MitraClip is currently the most widely implanted device for transcatheter mitral valve interventions. To further standardize the MitraClip TEER procedure, we have invited internationally renowned expert Professor Gilbert Tang to comprehensively demonstrate the standardized operational steps and key points of the MitraClip system in a step-by-step format, hoping it will benefit your learning and work. Overall, the MitraClip procedure for TEER is convenient, and beginners can easily get started by strictly following the Instructions for Use (IFU) step by step.
Video 1: CDS Insertion into the Left Atrium and Initial Positioning of SGC/CDS
Video Operational Key Points:
1. Introduction to SGC and Mitral Valve Demonstration Model
2. SGC Insertion into the Left Atrium
3. CDS Insertion into SGC
4. Straddling (Completion of Straddling)
Video Operational Key Points:
6. Unlock the clamps and open the clamp arms
7. Clipper Testing: Unlike the MitraClip G3, the MitraClip G4 introduces an independent clamping function in addition to simultaneous clamping, which is more conducive to clamping optimization and confirmation, thus requiring clip testing during the procedure.
8. Adjust the clamp direction under 3D orientation
Video Operational Key Points:
13. Closing the Clamp and Assessment: When the clamp closes to 60 degrees, if necessary, loosen the black screw on the DC handle to release the tension between the mitral clamp and the leaflet, then retighten the black screw on the DC handle.
14. System Removal: When withdrawing the CDS, stop the operation when the first non-radiopaque ring (silver marker) is visible, ensuring that the head of the delivery system remains within the clamp introducer; during the removal of the CDS and clamp introducer, maintain continuous negative pressure suction in the large sheath, and cover the large sheath hemostatic valve with a finger while removing the CDS.
▶The MitraClip G4 system has optimized the release operation compared to the G3 system, allowing for the simultaneous removal of the clamping line when lifting the clamping device, making the operation simpler.
Expert Introduction
Gilbert H.L.Tang
Mount Sinai Health System
Icahn School of Medicine at Mount Sinai
MD, graduated from Harvard University (Bachelor’s Degree), University of Toronto (Master of Medicine, PhD) and Harvard Business School (MBA), completed residency training at the University of Toronto. Currently serves as the Director of Structural Heart Surgery at the Mount Sinai Health System and Professor of Cardiovascular Surgery at the Icahn School of Medicine, Editor-in-Chief of JACC: Case Reports, Fellow of the Royal College of Physicians and Surgeons of Canada (FRCSC), Fellow of the American College of Cardiology (FACC), and the first Fellow of the Society for Cardiovascular Angiography and Interventions (FSCAI) in the United States. He has completed over 4,000 cases of TAVR, transcatheter mitral repair (MitraClip), transcatheter tricuspid repair (TriClip), and transcatheter mitral/tricuspid valve replacement.
He pioneered the cusp-overlap concept (optimizing self-expanding valve TAVR implantation) and the commissural alignment concept (precise valve positioning during TAVR). As a regularly invited faculty and guest speaker at domestic and international conferences, he has led several multicenter research projects on structural heart disease treatment (EXPLANT-TAVR, EXPLANTORREDO-TAVR, CUTTING-EDGE registry, Global 3D ICE Alliance, etc.), and served as the national committee member for several clinical trials such as the TRILUMINATE TriClip pivotal trial and APOLLO Intrepid TMVR pivotal trial. His research results and clinical outcomes have been published in numerous top medical journals and presented at various international conferences. He has trained physicians and cardiac teams from medical centers worldwide in performing transcatheter valve surgeries.
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