TEER is a catheter-based procedure that reduces a leaking mitral or tricuspid valve by clipping the valve leaflets together — without open-heart surgery. The most well-known device is MitraClip for the mitral valve, with TriClip now available for the tricuspid valve.
Transcatheter edge-to-edge repair works by bringing together the edges of a leaking valve's leaflets using a small clip device delivered through a catheter. For the mitral valve, a catheter is inserted through the femoral vein in the groin, advanced to the heart, and passed from the right atrium through the septum (the wall between the atria) to reach the left side of the heart. Using real-time echocardiographic and fluoroscopic guidance, the clip is positioned on the mitral valve leaflets and deployed — creating a "double orifice" that reduces the degree of regurgitation.
The concept is based on the surgical Alfieri stitch technique, which has been used by cardiac surgeons for decades. TEER translates this principle into a catheter-based approach suitable for patients at high surgical risk.
The MitraClip (Abbott) is the most widely used TEER device for mitral regurgitation. It is FDA-approved for both primary (degenerative) MR in patients at prohibitive surgical risk and secondary (functional) MR in patients with heart failure who remain symptomatic despite optimal medical therapy. The landmark COAPT trial demonstrated that MitraClip significantly reduced heart failure hospitalizations and improved survival in appropriately selected patients with functional MR.
Not every patient with mitral regurgitation is a good candidate for TEER. The best outcomes are seen when MR is sufficiently severe, the anatomy is favorable for clip placement, and the patient has been optimized on medical therapy first. Your structural heart team will use echocardiography to assess candidacy carefully.
The TriClip (Abbott) applies the same edge-to-edge repair principle to the tricuspid valve. Severe tricuspid regurgitation causes debilitating symptoms including fluid retention, leg swelling, abdominal bloating, and fatigue. The TRILUMINATE Pivotal trial demonstrated symptom improvement with TriClip in patients with severe TR, earning FDA approval. The procedure is performed entirely through the venous system (no need to cross the septum), making it technically distinct from mitral TEER.
TEER is performed under general anesthesia (due to the need for transesophageal echocardiography to guide the procedure). The procedure typically takes 1–3 hours. Hospital stay is usually 1–3 days. Most patients experience improvement in symptoms — particularly breathlessness and fatigue — within weeks. One or more clips may be placed depending on the anatomy and degree of leakage.
Risks include bleeding, residual or recurrent regurgitation, device detachment (rare), atrial septal defect (the small hole created to cross the septum usually closes on its own or remains clinically insignificant), and, rarely, need for urgent surgery. The overall complication rate is low compared to open surgical repair or replacement.