All about the TAVI and mitral TEER procedures

Heart valve disease can significantly impact a person’s quality of life, or those with other medical conditions. Two minimally invasive procedures – TAVI (Transcatheter Aortic Valve Implantation) and Mitral TEER (Transcatheter Edge-to-Edge Repair) – have become important options for treating valve dysfunction without the need for open-heart surgery. Although both address structural heart disease, they treat different valves using distinct techniques.

What is the difference between aortic and mitral valve disease?

Aortic valve disease involves the valve that controls blood flow from the heart’s left ventricle to the rest of the body. When this valve becomes narrowed (aortic stenosis), the heart must work harder to pump blood through the narrowed opening. This can lead to:

Chest pain (angina)
Shortness of breath
Fatigue
Lightheadedness or fainting (syncope)

Mitral valve disease involves the valve that regulates blood flow between the left atrium and left ventricle. When the valve is leaky (mitral regurgitation), blood flows backward into the atrium, which can cause:

Shortness of breath (especially when lying flat or during exertion)
Swelling in the legs or abdomen
Irregular heart rhythms (such as atrial fibrillation)
Fatigue and reduced exercise capacity

What is TAVI and who is it for?

TAVI is a minimally invasive procedure to replace a narrowed aortic valve. A catheter is typically inserted through a blood vessel in the groin (femoral approach), guiding a new valve to the heart. The replacement valve is expanded within the diseased native valve and begins functioning immediately.

TAVI is typically considered for:

Patients with severe symptomatic aortic stenosis who are aged 75 or above
Those are aged 65 or older but at high risk for open-heart surgery due to age, frailty, or other medical conditions
Selected intermediate- or low-risk patients, based on clinical evaluation and imaging

What is Mitral TEER and who is it for?

Mitral TEER (commonly known by the brand name MitraClip or Pascal) is used to treat mitral regurgitation (a leaky mitral valve). A clip is delivered through a vein in the leg and attached to the mitral valve to bring the valve leaflets closer together, thereby reducing leakage.

Mitral TEER may be suitable for:

Patients with moderate-to-severe mitral regurgitation
Those at high surgical risk for conventional mitral valve repair or replacement
Selected patients with heart failure and functional (secondary) mitral regurgitation, based on imaging and guideline-based criteria

How are TAVI and Mitral TEER similar?

Both procedures are:

Minimally invasive – avoiding the need for sternotomy (opening the chest)
Performed under image guidance using echocardiography and fluoroscopy
Designed to improve quality of life and reduce heart failure symptoms
Associated with faster recovery compared to open surgery

How do they differ?

Valve treated: TAVI targets the aortic valve; Mitral TEER addresses the mitral valve
TAVI carried out under sedation or general anaesthesia, while TEER is carried out under general anaesthesia only
Treatment approach: TAVI replaces the valve; Mitral TEER repairs it without removal
Indications: TAVI is for stenosis; Mitral TEER is for regurgitation
Procedural complexity: Mitral TEER is often more technically challenging due to valve anatomy

What should patients consider?

The decision between TAVI, Mitral TEER, or other treatment options depends on:

The type and severity of valve disease
The patient's overall health and surgical risk
Heart function, anatomy, and coexisting cardiac conditions

Each case is evaluated by a multidisciplinary heart team, including cardiologists, cardiac surgeons, and imaging specialists. Advanced imaging (such as echocardiography and CT scans) helps guide personalised treatment planning.