BOOK AN APPOINTMENT

Where Compassion Meets Cardiovascular Excellence

MitraClip in Hyderabad — Transcatheter Mitral Valve Repair at AIG Hospitals, Gachibowli

Home Resources

MitraClip in Hyderabad — Transcatheter Mitral Valve Repair at AIG Hospitals, Gachibowli

MitraClip is a minimally invasive procedure that repairs a leaking mitral valve — the valve between the two left chambers of the heart — without any chest incision or open-heart surgery. A small clip is guided through a vein in the groin directly to the mitral valve, grasping the leaking leaflets together and immediately reducing the amount of blood leaking backwards. Dr. Bhishma Chowdary performs MitraClip and transcatheter edge-to-edge repair (TEER) at AIG Hospitals, Gachibowli, Hyderabad — part of a dedicated structural heart programme serving patients from Gachibowli, Hitech City, Manikonda, Jubilee Hills, and across Telangana and Andhra Pradesh.

At a glance

Procedure Type Transcatheter Edge-to-Edge Mitral Valve Repair (TEER).
Device MitraClip (Abbott) — available in NTR, XTR, NTW, and XTW clip sizes to accommodate different mitral valve anatomies.
Condition Treated Significant mitral regurgitation (MR), including both primary (degenerative) and secondary (functional) mitral valve disease.
Access Femoral vein access through the groin, followed by transseptal puncture to reach the left atrium and mitral valve.
Guidance Continuous 3D transesophageal echocardiography (TOE/TEE) guidance throughout the procedure.
Anaesthesia General anaesthesia is typically used, as full TOE guidance requires the patient to remain completely still.
Duration Approximately 2 to 4 hours, depending on valve anatomy, procedural complexity, and the number of clips required.
Hospital Stay Usually 3 to 5 days.
Recovery Patients generally begin walking on Day 2, are discharged between Days 3 and 5, and achieve full recovery within 4 to 6 weeks.
Performed By Dr. Bhishma Chowdary, DM Cardiology — Structural Heart Specialist, AIG Hospitals.
Appointment +91-9000352998

What is MitraClip and how does it work?

The mitral valve is the gateway between the left atrium — which receives oxygenated blood from the lungs — and the left ventricle — which pumps it to the body. In a healthy heart, the two leaflets of the mitral valve close tightly with each heartbeat, preventing any backflow. In mitral regurgitation, the leaflets fail to close properly — allowing blood to leak backwards into the left atrium instead of being pumped forward. Over time, this volume overload enlarges and weakens the left heart, causing breathlessness, fatigue, and eventually heart failure.

The MitraClip device — a small metal clip approximately the size of a shirt button, covered in polyester fabric — is delivered to the mitral valve via a catheter passed through the femoral vein in the groin. The catheter crosses the atrial septum (the wall between the upper chambers) through a small puncture — the transseptal approach — and enters the left atrium. Under continuous real-time guidance from a 3D transesophageal echocardiogram (TOE), the clip grasps both leaflets at their central point — where leakage is greatest — and clips them together. This creates a double-orifice mitral valve: two smaller openings instead of one large leaking one. The backflow of blood is immediately and substantially reduced.

Why MitraClip is transformative

Before MitraClip, patients with severe mitral regurgitation who were too frail or high-risk for open-heart surgery had no effective treatment for their valve disease — only medications to manage symptoms. MitraClip has changed this completely, offering valve repair to patients who would otherwise have progressive heart failure with no interventional option. It has been used in over 200,000 patients worldwide since its introduction.

Anatomy requirements — what the TOE must shows

Not all patients with MR are anatomically suitable for MitraClip. Dr. Bhishma Chowdary performs a comprehensive 3D transesophageal echocardiogram before recommending MitraClip, assessing:

1. Primary (degenerative) mitral regurgitation

The valve leaflets themselves are abnormal — most commonly from mitral valve prolapse (Barlow disease, fibroelastic deficiency) where one or both leaflets billow into the left atrium during systole. MitraClip is indicated for:

  • Severe symptomatic primary MR in patients at prohibitive or high surgical risk — age, frailty, severe lung disease, prior cardiac surgery, or severe left ventricular dysfunction
  • Patients with severe primary MR who decline surgical repair after full informed discussion
  • Selected patients with moderate-severe primary MR causing significant symptoms despite optimal medical therapy

2. Secondary (functional) mitral regurgitation

The valve leaflets are structurally normal but the left ventricle is enlarged and weakened — from ischaemic heart disease or dilated cardiomyopathy — distorting the valve geometry and preventing leaflet coaptation. MitraClip for secondary MR is indicated for:

  • Patients with heart failure (EF below 50%) and moderate-severe or severe secondary MR despite at least 3 months of optimal medical therapy including GDMT (ACE inhibitor/ARNI, beta-blocker, MRA, SGLT2 inhibitor) and CRT where appropriate
  • Patients who remain symptomatic with NYHA Class II, III, or ambulatory Class IV heart failure
  • Suitable anatomy on 3D TOE assessment — adequate leaflet length, adequate coaptation length, and acceptable mitral valve area

The COAPT trial — landmark evidence for secondary MR

The COAPT trial (2018, NEJM) — 614 patients with heart failure and secondary MR — demonstrated that MitraClip plus guideline-directed therapy significantly reduced heart failure hospitalisations by 47% and all-cause mortality by 38% at 2 years compared to medical therapy alone. This established MitraClip as the standard of care for appropriately selected secondary MR patients and transformed international guidelines.

Anatomy requirements — what the TOE must show

Not all patients with MR are anatomically suitable for MitraClip. Dr. Bhishma Chowdary performs a comprehensive 3D transesophageal echocardiogram before recommending MitraClip, assessing:

  • Mitral valve area — must be above 4.0 cm² after clip placement to avoid iatrogenic mitral stenosis
  • Regurgitant jet origin — central or paracentral jets are most suitable; eccentric jets from one commissure are more challenging
  • Leaflet length — adequate length required to grasp and clip
  • Coaptation depth — gap between leaflets that must fall within acceptable range
  • Calcification — heavy leaflet or annular calcification reduces grasping success
  • Mitral annulus dimensions — important for clip size selection (NTR, XTR, NTW, XTW)

MitraClip vs surgical mitral valve repair — how is the choice made?

Surgical Repair Preferred When Young patients (generally under 65 years) with primary (degenerative) mitral regurgitation, low surgical risk, and anatomy suitable for durable repair. Surgical mitral valve repair typically provides more complete elimination of mitral regurgitation than MitraClip in primary MR and has over 20 years of long-term durability data. Appropriate patients may be referred for surgical repair following Heart Team evaluation.
MitraClip Preferred When Patients are at high or prohibitive surgical risk, are older than 75 years, have frailty, severe lung disease, prior sternotomy (increased redo surgery risk), or have secondary (functional) mitral regurgitation associated with heart failure. MitraClip is also preferred when patients choose a catheter-based approach after a detailed discussion of risks and benefits. The COAPT trial demonstrated significant benefits in appropriately selected patients with secondary MR.
When Both Are Valid Options Intermediate-risk patients with primary mitral regurgitation may be suitable candidates for either surgery or MitraClip. In these cases, shared decision-making between the interventional cardiologist, cardiac surgeon, and patient is essential, balancing the superior MR reduction and durability of surgery against the lower procedural risk and faster recovery associated with MitraClip.

Heart Team decision at AIG Hospitals, Gachibowli

Every MitraClip case at AIG Hospitals is reviewed by the multidisciplinary structural Heart Team — Dr. Bhishma Chowdary (structural heart interventional cardiologist), cardiac surgeon, and imaging echocardiographer — before a recommendation is made. This ensures the right procedure is recommended for the right patient. Patients with primary MR who are surgical candidates are referred for surgery; those who are not, or who prefer catheter-based repair, are offered MitraClip.

How is the MitraClip procedure performed? Step by step

Pre-procedure preparation

  • Full 3D transesophageal echocardiogram — the most important planning investigation. Assesses anatomy in multiple planes, measures leaflet dimensions, identifies the origin of the regurgitant jet, and selects clip size.
  • CT angiography of femoral vessels — confirms access route from groin to inferior vena cava.
  • Coronary angiogram — significant coronary artery disease is addressed before MitraClip if present.
  • Fasting from midnight before the procedure.
  • Anticoagulation and antiplatelet review — aspirin typically continued; specific anticoagulation protocol applied.

In the hybrid catheterisation laboratory

  1. General anaesthesia is administered. A transesophageal echo (TOE) probe is placed — providing real-time 3D imaging of the mitral valve throughout the procedure.
  2. The right femoral vein in the groin is accessed. A long steerable guide catheter is advanced under X-ray guidance to the right atrium.
  3. Transseptal puncture — a needle punctures the atrial septum (the wall between the right and left atria) at a precisely chosen location, guided by TOE and X-ray. This creates the pathway into the left atrium. The location of this puncture critically affects the angle of approach to the mitral valve.
  4. The MitraClip delivery system is advanced through the transseptal sheath into the left atrium. The steerable guide catheter allows precise positioning above the mitral valve.
  5. The open clip is advanced through the mitral valve into the left ventricle, oriented perpendicular to the line of leaflet coaptation. Real-time 3D TOE imaging confirms correct orientation.
  6. The clip is withdrawn back towards the left atrium — as it is slowly pulled back, the open arms of the clip grasp both mitral leaflets. Grasping is confirmed on 3D TOE by visualising both leaflets caught in the clip arms.
  7. The clip is partially closed to assess the result. Colour Doppler on TOE measures the residual mitral regurgitation. The mitral valve area is measured to ensure no significant stenosis.
  8. If the result is satisfactory — MR reduced to mild or less — the clip is fully closed and released from the delivery cable. It remains permanently attached to the leaflets.
  9. If further MR reduction is needed, a second clip is delivered adjacent to the first. Multiple clips can be placed. Up to 4 clips have been placed in complex cases.
  10. Final TOE assessment confirms MR reduction, valve area, and absence of complications. The delivery system is removed. Femoral venous access is closed.

After the procedure

  • Transfer to cardiac ICU or high-dependency unit for 12 to 24 hours — continuous ECG and haemodynamic monitoring.
  • TOE typically not repeated post-procedure — the intraprocedural TOE assessment is comprehensive.
  • Transthoracic echocardiogram before discharge — confirms clip position, residual MR, and mitral valve gradient.
  • Antiplatelet therapy — aspirin plus clopidogrel for 3 months, then aspirin alone lifelong. Anticoagulation if AF is present.
  • Antibiotic prophylaxis for dental procedures for 6 months after MitraClip — while the clip surface is endothelialising.
  • Heart failure medications (GDMT) continued and optimised — MitraClip supplements but does not replace medical therapy.
  • Discharge on day 3 to 5. Follow-up echocardiogram at 1 month and 6 months.

    • What can patients expect after MitraClip?

    Most patients who undergo successful MitraClip notice improvement within the first few weeks:

    • Breathlessness on exertion — typically improves significantly within 1 to 4 weeks as the heart adjusts to the reduced volume overload.
    • Exercise tolerance — progressive improvement over 3 to 6 months as left ventricular reverse remodelling occurs.
    • Heart failure hospitalisations — significantly reduced in secondary MR (COAPT trial showed 47% reduction).
    • Quality of life — measured improvements in 6-minute walk distance and NYHA functional class in the majority of patients.
    • Left ventricular dimensions — gradual reduction in left heart size over 3 to 12 months as the volume overload is relieved.

    Patients with secondary MR and severely reduced EF may take 3 to 6 months to experience the full benefit — as the struggling heart muscle slowly recovers with reduced workload.

    How long does MitraClip last?

    Long-term durability data for MitraClip is now available from multiple large registries. The EVEREST II trial 5-year follow-up and the COAPT trial 5-year outcomes demonstrate:

    • Freedom from MR recurrence (above moderate) at 5 years is approximately 80 to 85% — the clip remains attached and functional in the large majority of patients.
    • Clip detachment — full or partial separation from the leaflets — occurs in less than 2% of cases.
    • Clip embolisation — extremely rare with modern delivery systems.
    • If the clip fails or MR recurs significantly, options include a second MitraClip procedure (clip-in-clip) or surgical referral — though redo surgery after MitraClip is technically more demanding.

    Valve-in-valve planning for younger patients

    For younger patients receiving MitraClip, Dr. Bhishma Chowdary discusses the long-term plan — including whether future surgical repair would be feasible if the clip result deteriorates, and whether the anatomy allows for a future clip-in-clip procedure if needed. This forward planning at the time of the initial procedure is an important part of the structural heart assessment at AIG Hospitals.

    MitraClip near you — Gachibowli, Hitech City, Manikonda and Hyderabad

    AIG Hospitals, Gachibowli is a dedicated structural heart centre offering MitraClip as part of a comprehensive transcatheter valve programme. Patients attend from across Hyderabad and the wider region:

    Gachibowli AIG Hospitals is located in Gachibowli, serving as a major centre for advanced structural heart interventions.
    Hitech City / HITEC City Approximately 8 to 12 minutes from AIG Hospitals with convenient access through Hyderabad's IT corridor.
    Manikonda Located around 12 to 15 minutes away via the Financial District road.
    Kondapur Approximately 10 to 15 minutes from AIG Hospitals via the HITEC City main road.
    Jubilee Hills Roughly 20 to 25 minutes away. Many patients are referred from this area for specialised cardiology and structural heart procedures.
    Banjara Hills Approximately 20 to 25 minutes from AIG Hospitals with easy connectivity through major city routes.
    Secunderabad Typically 35 to 40 minutes away via the Outer Ring Road (ORR), depending on traffic conditions.
    Warangal / Karimnagar Patients travel from across Telangana for advanced structural heart procedures that may not be available at district-level hospitals.
    Kurnool / Vijayawada Patients from Andhra Pradesh are frequently referred for specialised structural heart interventions, including MitraClip and TAVR procedures.

    Book a MitraClip consultation in Hyderabad

    If you or a family member has been told they have a leaking mitral valve and are not suitable for surgery — or if you want a specialist structural heart assessment — contact Dr. Bhishma Chowdary at AIG Hospitals, Gachibowli. Bring your echocardiogram report and CD to the consultation. Call +91-9000352998 | Mon–Sat 10 AM–4 PM | AIG Hospitals, Gachibowli, Hyderabad 500032

    Frequently asked questions — MitraClip in Hyderabad

    What is MitraClip and is it available in Hyderabad?

    MitraClip is a catheter-based device that repairs a leaking mitral valve by clipping the two leaflets together at their leaking point — without any chest incision or open-heart surgery. It is performed through a vein in the groin under general anaesthesia with guidance from a 3D heart ultrasound (transesophageal echocardiogram). MitraClip is available at AIG Hospitals, Gachibowli, Hyderabad — performed by Dr. Bhishma Chowdary as part of the structural heart programme.

    Who is suitable for MitraClip?

    MitraClip is suitable for patients with significant mitral regurgitation (leaking mitral valve) who are at high risk for open-heart surgery, or who have heart failure with secondary functional MR. The specific requirements are: MR graded moderate-severe or severe on echocardiogram, symptoms despite optimal medications, and anatomy suitable for clip placement confirmed on 3D transesophageal echocardiogram. A formal Heart Team assessment — including Dr. Bhishma Chowdary and a cardiac surgeon — is required before recommending MitraClip.

    How is MitraClip different from surgery?

    Surgical mitral valve repair involves opening the chest, stopping the heart, and physically repairing the valve leaflets — requiring a heart-lung machine and 6 to 8 weeks of recovery. MitraClip is performed through a small puncture in the groin vein, guided by ultrasound, with no chest incision, no heart-lung machine, and general anaesthesia. Most patients are discharged within 3 to 5 days and walking within 24 hours. The tradeoff is that surgery typically achieves better MR elimination — MitraClip reduces MR significantly but rarely eliminates it completely. For patients at high surgical risk, MitraClip's benefits far outweigh this.

    Will I still need heart failure medications after MitraClip?

    Yes — MitraClip reduces the volume of leaking blood and improves symptoms and heart failure outcomes, but it does not replace medications. Guideline-directed medical therapy — ACE inhibitor or ARNI, beta-blocker, spironolactone, and SGLT2 inhibitor — should be continued and optimised after MitraClip. The combination of MitraClip plus optimal medical therapy produces the best outcomes, as demonstrated in the COAPT trial.

    How long does the MitraClip procedure take?

    The MitraClip procedure typically takes 2 to 4 hours depending on the complexity of the valve anatomy and the number of clips required. Straightforward cases with a single central jet and normal leaflet anatomy are typically completed in 2 to 2.5 hours. Complex cases — eccentric jets, very mobile leaflets, or cases requiring 3 or more clips — take longer. You are under general anaesthesia throughout and will not be aware of the procedure duration.

    Is MitraClip covered by insurance in India?

    MitraClip device and procedure costs are covered by a growing number of health insurance policies in India. Coverage depends on your specific policy, insurer, and whether MitraClip is listed as a covered cardiac procedure. Our patient care team at AIG Hospitals assists with insurance pre-authorisation. Call +91-9000352998 for guidance on insurance coverage for your specific situation.

    Can MitraClip be repeated if the valve leaks again?

    Yes — if significant MR recurs after MitraClip, the procedure can be repeated. A second clip can be placed adjacent to the first (clip-in-clip or parallel clips) if anatomy permits. Long-term data shows that approximately 15 to 20% of patients require a repeat procedure within 5 years. Some patients with recurrent MR after MitraClip may also be reassessed for surgical repair — this is always discussed with the cardiac surgeon as part of the Heart Team.

    I have been told I need surgery for my mitral valve but I am too old — can MitraClip help?

    Yes — this is exactly the patient population MitraClip was developed for. Patients who have been declined surgery due to age, frailty, poor lung function, kidney disease, or prior cardiac surgery are often excellent candidates for MitraClip. Dr. Bhishma Chowdary sees many patients in this situation at AIG Hospitals, Gachibowli — bring your echocardiogram report and surgical assessment letter to the consultation so the Heart Team can give you a specific recommendation.

    What is the difference between MitraClip and TAVR?

    TAVR (Transcatheter Aortic Valve Replacement) replaces the aortic valve — the valve on the left side of the heart that opens to let blood out to the body. MitraClip repairs the mitral valve — the valve between the two left heart chambers. Both are transcatheter structural heart procedures performed without open-chest surgery at AIG Hospitals, Gachibowli. Some patients have both conditions — aortic stenosis and mitral regurgitation — and require assessment by Dr. Bhishma Chowdary to determine the sequence and approach for treating both.

    Why choose Dr. Bhishma Chowdary for MitraClip at AIG Hospitals, Hyderabad?

    • Dedicated structural heart specialist — TAVR, MitraClip, transcatheter mitral valve-in-valve, ASD device closure, PFO closure all performed as part of an integrated structural heart programme.
    • Presented original research on transcatheter mitral valve-in-valve at TCTAP Seoul — international conference recognition of structural heart expertise.
    • 3D transesophageal echocardiography expertise — the most critical skill for MitraClip guidance. TOE-guided MitraClip requires real-time 3D echo interpretation that is performed by Dr. Bhishma Chowdary himself, not outsourced to a separate echocardiographer.
    • Heart Team approach — every MitraClip case reviewed jointly with a cardiac surgeon before proceeding. The right patient gets the right procedure — surgery if appropriate, MitraClip if not.
    • Full structural heart infrastructure at AIG Hospitals, Gachibowli — hybrid catheterisation laboratory, cardiac ICU, cardiac surgery backup, cardiac anaesthesia, and cardiac rehabilitation.
    • Experience with complex MitraClip anatomy — eccentric jets, heavily prolapsing leaflets, and cases requiring multiple clips.
    • COAPT-aligned patient selection — strict adherence to the trial criteria that define which heart failure patients benefit from secondary MR MitraClip.
    • Fluent consultations in English, Hindi, and Telugu.

    Book a MitraClip consultation in Hyderabad

    If you have been diagnosed with significant mitral regurgitation, have been told you are not suitable for surgery, or are experiencing breathlessness and reduced exercise capacity from a leaking mitral valve — contact Dr. Bhishma Chowdary at AIG Hospitals, Gachibowli, Hyderabad for a specialist structural heart consultation. Please bring your most recent echocardiogram report and CD, and any surgical assessment letters.

    Serving patients from Gachibowli, Hitech City, Manikonda, Kondapur, Jubilee Hills, Banjara Hills, Secunderabad, and across Telangana and Andhra Pradesh.

    Call: +91-9000352998

    Email: bhishmachowdary@gmail.com

    Location: AIG Hospitals, Gachibowli, Hyderabad — 500032

    Clinic hours: Monday to Saturday, 10:00 AM to 4:00 PM