TEER: transcatheter edge-to-edge repair for leaking valve
A catheter-based repair for mitral or tricuspid regurgitation, using a clip to reduce leakage without open-heart surgery.
In short
Transcatheter edge-to-edge repair, or TEER, treats a leaking mitral or tricuspid valve by clipping the valve leaflets together at the point of the leak, so that the valve closes more completely. It is performed through a vein in the groin, without opening the chest or stopping the heart. It is used mainly in patients for whom conventional surgery carries high risk, and where symptoms persist despite optimal medical treatment. It reduces rather than abolishes leakage, and suitability depends closely on the anatomy of the valve.
Call 999 for severe breathlessness at rest, chest pain or fainting. Worsening breathlessness or increasing ankle swelling in known valve disease should prompt prompt review rather than waiting.
Key facts
- TEER treats leaking valves; it is not a treatment for a narrowed valve.
- Access is through a vein in the groin, and the chest is not opened.
- It is typically considered when symptoms persist despite optimal medical therapy and surgery carries high risk.
- Detailed imaging, including transoesophageal echocardiography, determines whether the anatomy is suitable.
- The aim is to reduce leakage substantially and improve symptoms, not necessarily to eliminate it completely.
The problem it addresses
The mitral valve separates the upper and lower chambers on the left side of the heart; the tricuspid valve does the same on the right. When either fails to close properly, blood leaks backwards with each beat. This is regurgitation, and the heart compensates by working harder and enlarging.
Over time that leads to breathlessness, reduced exercise capacity, fatigue, fluid retention and, frequently, atrial fibrillation. Significant regurgitation may result from a problem with the valve itself, such as a prolapsing or damaged leaflet, or it may be secondary: the valve is structurally normal but the chamber has enlarged so that the leaflets no longer meet. The distinction affects which treatments are likely to help.
What the procedure involves
A catheter is passed through a vein in the groin to the right side of the heart. For the mitral valve, the catheter crosses the wall between the upper chambers to reach the left side. A small clip is then positioned so that it grasps both valve leaflets at the point where they fail to meet, holding them together at that point. The valve then closes around two smaller openings instead of one leaking one.
The procedure is performed under general anaesthetic, guided by X-ray and continuous transoesophageal echocardiography, which allows the operator to see the leak reduce in real time and to adjust the clip position before releasing it. More than one clip is sometimes used.
Who may be suitable
Suitability is determined largely by anatomy. Detailed transoesophageal echocardiography, and often CT imaging, is used to assess whether the leaflets can be grasped safely and whether narrowing the valve in the process would create a new problem.
The procedure is generally considered when regurgitation is severe, when symptoms persist despite properly optimised medical treatment, and where a specialist heart team judges that conventional surgery carries high risk. For secondary regurgitation associated with heart failure, ensuring that heart failure medication and device therapy have been fully optimised first is an essential part of the assessment, because that alone sometimes reduces the leak substantially.
What to expect
Hospital stay is typically short, often a few days, and recovery is considerably quicker than after open-heart surgery. Because access is venous and no incision is made in the chest, the access site usually heals quickly.
Recognised risks include bleeding at the access site, effects on the atrial septum where it has been crossed, partial detachment of the clip, and creating some narrowing of the valve. These are discussed individually before consent, with figures relevant to your own anatomy and general condition.
Follow-up involves echocardiography to assess the residual leak and how the heart chambers respond, alongside continued medical treatment. It is important to understand that the goal is meaningful reduction of leakage and improvement in symptoms, rather than a perfectly competent valve. For the right patient, that reduction can make a substantial difference to breathlessness and to how much they can do.
Sources
This page provides general information and does not replace individual medical advice, diagnosis or emergency care. Decisions about tests and treatment depend on your own history, examination and results.