MitraClip and MyClip — TEER Systems for Mitral regurgitation

MitraClip is used to address severe symptomatic primary or secondary MR in selected patients. 
The typical anatomy involves a single, central leak, where the middle parts of the anterior and posterior leaflets (called A2 and P2) fail to meet properly. It tends to work better on this type of leak, as opposed to several widely separated leaks. Additionally, it requires enough healthy, mobile leaflet tissue to grasp. Also, the LVEF needs to be between 20-50% and the LV end-systolic diameter should be no more than 70mm.

Less favoured anatomy includes severe leaflet calcification, a short posterior leaflet, major leaflet cleft, a Barlow-type disease or marked bileaflet prolapse, or a small baseline valve area or high transmitral gradient (pressure difference between the left atrium and ventricle, when blood is flowing through the mitral valve).

 

The MyClip system also has similar anatomical requirements. Where it differs is the device steering and orientation. MyClip offers 60°, 120°, 180° and reversed positions, as presets. These are designed to work better in smaller and more complex anatomies. However, there isn’t enough research to show that it has excelled over the MitraClip in any difficult sub-anatomy group. MitraClip’s G4 system offers a choice of shorter/longer and standard/wide clip sizes, alongside independent leaflet grasping, to match leaflet length and the width of the leak. As of May 2026, Abbot has released an update to the G4 system; the G5 is now commercially available, although the body of data on its performance is still relatively shallow.

 

 



The biggest difference is design emphasis — MitraClip offers a variety of clip sizes to suit different anatomies, while MyClip works with one main clip design and instead focuses on steering positions, to improve precision.


MitraClip and MyClip systems are used to treat Primary MR, Secondary MR and selected atrial functional MR. 

Primary MR is when the valve itself is abnormal — prolapse, flail leaflets, chordal rupture or endocarditis-related damage. Secondary MR is when the valve has no anatomical issues, but a weakened left ventricle pulls the valve apart. Secondary MR is common in heart failure or ischemic cardiomyopathy. Atrial functional MR is caused by an enlargement of the left atrium and mitral annulus, and is often linked to atrial fibrillation. MR is a side-effect of this.

Symptoms across these categories of MR are breathlessness, ankle swelling, chronic fatigue, palpitations, repeated fluid buildup in the lungs, and a drastically reduced tolerance for physical activity. The first line of intervention is medications.

 

When the symptoms do not respond to medications, a TEER may be considered. This is particularly favoured when the patient is of a higher risk profile due to old age, frailty, reduced cardiac output, a previous bypass or valve surgery, severe lung or kidney disease, or other serious medical complications.

 

From a broader standpoint, doctors tend to assess the extent to which the leak is affecting daily life. Only if it is significantly impacting life quality is a TEER considered.

The choice between MitraClip and MyClip often comes down to three factors: Cost, the surgical team’s experience and preference, and patient anatomy. 



 

Typically, the MitraClip procedure can cost anywhere between ₹20-30 lakh. The biggest cost is the clipping system itself. Additional procedural costs like diagnostics, cath lab usage, ICU/ward stay, medicines and pre-procedural testing is usually standardized. 



 

The MyClip procedure is positioned as the more affordable Indian alternative, with reports showing an overall procedure cost of roughly ₹15 lakh. 



 

Besides the standard factors, the number of clips used also adds to the cost.

 

Step-by-Step guide:

For mitral TEER, the very first step is a pre-procedure evaluation. Medical teams have gotten stricter with the consistency and timeliness of these evaluations to ensure that closer to the time of the procedure, parameters are as stable as possible.

 

A detailed transthoracic or transesophageal echo (usually 3D) is the first step to quantify MV regurgitation and anatomy. It helps medical teams understand mechanism, leaflet anatomy, coaptation gap, calcification levels, LV function and pulmonary pressures. 



 

After this, a CT Angiogram or regular angiogram is conducted, this is to optimize for heart failure, blockages and other potential risks. Geriatric and anesthetic risk assessment is also done via a heart team. Here, doctors may explain the concept of biological and chronological age. Chronological age refers to the age of the person, while biological age refers to the level at which organs are functioning and the age it’s representative of. For example; a 68 year old can have a biological age of 75, due to advanced deterioration of some organs. The medically relevant aspect is biological age and not chronological age.

 

The procedure itself is conducted in a cath lab or hybrid lab, under general anesthesia or deep sedation. The preferred route, as with most catheterization procedures, is femoral vein access. A transseptum puncture is made to enter the left atrium; fluoroscopy or a 3D TEE guides the steerable guide catheter.

 

The next step is device navigation and actual clipping. The tricky part here is grasping the leaflets and aligning them properly for clipping. The clip system is advanced into the left atrium and oriented towards the regurgitant section. Under a TEE for guidance, the clip is aligned, crosses into the LV and then retracts to grasp anterior and posterior mitral leaflets at the target segment. When the clipping is finished, a double-orifice valve is created.

 

An immediate echo assessment is done to gauge reduction in mitral valve regurgitation. If the regurgitation remains significant, an additional clip may be planted. Hemodynamic parameters are monitored next, and once the reduction in MR is satisfactory the clip is detached, venous access closed and the patient is moved to monitored care.

The single biggest advance in modern TEER procedures are varied clip sizes, as opposed to a ‘one clip fits all’ approach. Modern TEER is highly anatomy specific, to produce better outcomes.

 

MitraClip’s G4 system introduced different clip widths and lengths, independent leaflet grasping and improved control for broad jets, asymmetric leaflet capture, and more complex prolapse patterns. 



 

MyClip’s technology is designed on the basis of different steering angles — presets of 60°, 120°, 180° and reversed positions. From these fixed positions, the doctors can further fine tune (for example; they can select a preset of 120°, and fine tune to 126°). This allows them to clip more precisely to the leaking part of the mitral valve. The presets are meant to make it easier to line up the clip, fine tune positioning, pass it safely into the left ventricle and adjust its directions without damaging delicate valve leaflets or supporting chords. 



 

The MitraClip’s guide catheter, in comparison, has a +/- knob which requires manual, continuous steering. 

Both systems offer multiple clipping.

Following TEER, most patients spend anywhere between 1-3 days in the hospital, depending on the particulars of their condition and overall health. Monitoring and medicines are started on the same day, and gentle walking is encouraged on the same or next day. Groin discomfort (tenderness and pain) is common, as is overall fatigue. Obviously, pain levels are very mild compared to heart surgery.

 

At home, the main focus is on gradual walking and resuming home tasks. Doctors stress on listening to the body as opposed to just pushing through recovery. Short walks and no heavy lifting for a couple of weeks, and any sort of increased breathlessness and chest pain is to be treated like a red flag.

 

Many return to basic household tasks or office work within a couple of weeks. Those in very physically-intensive occupations may have to wait for a bit more. Regular follow ups and echocardiograms check how well the valve is working and guide medications.

 

From a lifestyle perspective, the obvious still applies — healthy eating, reduced/no smoking and alcohol intake, low salt intake and constant daily movement to understand how the heart is responding. Fried foods, oily preparations and heavily processed foods and sugars are not recommended. Restrict the use of full-fat dairy, ghee and butter. Switch over to cold-pressed oils and more greens with lean meats.

 

Food can be a very emotional and cultural topic, and it’s necessary to change, with flavour profiles intact. This tends to produce significantly higher adherence.

Any procedure comes with its risks and TEER is no different. Of course, it carries lower risks than surgery, but that doesn’t mean there are none.

 

Periprocedural risks:



These are things that can go wrong during the procedure. Vascular complications like femoral access, bleeding or hematoma need to be accounted for. Pericardial effusion/tamponade is a risk, device embolization or even leaflet injury could occur. Although these are rare at super-speciality/high-volume centers.

 

There is a chance the procedure only offers partial MR reduction. This limits its benefit and necessitates a repeat intervention. Sometimes, clip detachment or loss of leaflet insertion can also require another TEER or even surgery.

 

There is no strong indicator for stroke or increased mortality rates, as compared to medical therapy. However, this is dependent on ventricular function and other comorbidities. So, cardiovascular complications are always a factor. 

While surgery does leave less room for revisions, TEER revisions are at approximately 9% around the 5 year mark.

The most obvious benefit is symptom relief — breathlessness and fatigue are significantly lowered, and exercise tolerance is greater. The 6-minute walk test is a good benchmark — a person has to walk up and down a 30 meter flat stretch at a fast pace. Almost always, patients will find that they can do this better than before.

 

Compared to surgery, TEER offers a reduced hospital stay and time in the ICU. It also offers a far quicker return to daily activities.

 

For frail, high-risk patients TEER is very meaningful in improving the quality of life, even if survival impact is modest. These are people often left with the choice of no surgical resolution, or gentle optimization.