The National Institute for Health and Care Excellence (NICE) issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on Percutaneous mitral valve leaflet repair for mitral regurgitation in August 2009. NICE is currently updating this guidance. Until then the NHS should continue to follow the recommendations outlined in the current version of the guidance. The Interventional Procedures Advisory Committee (IPAC) will consider this procedure review and NICE will issue an interventional procedures consultation document about its safety and efficacy for 4 weeks’ public consultation. IPAC will then review the consultation document in the light of comments received and produce a final interventional procedures document, which will be considered by NICE before guidance is issued to the NHS in England, Wales, Scotland and Northern Ireland.
Status In progress
Process IP
ID number 664
Description PMVR is a treatment option for MR if the mitral valve meets the anatomical eligibility criteria for coaption length, coaption depth, flail gap and flail width. It involves the use of a clip that mimics a surgical technique known as the ‘Alfieri stitch’. The procedure is done under general anaesthesia using transoesophageal echocardiography guidance and the optional use of fluoroscopy. Access is provided through the femoral vein and an atrial trans-septal puncture is done to reach the delivery site. The device is lowered through the mitral valve into the left ventricle. The arms of the clip grip the leaflets, bringing them closer together, and the clip is released from the delivery system. Adequate reduction of MR is assessed using echocardiography. If the reduction in MR is inadequate with 1 device it may be removed, or a second device placed alongside the first. After the procedure, patients usually have anti-platelet therapy for 6 months.

Provisional Schedule

Expected publication 17 April 2019


Key events during the development of the guidance:

Date Update
05 December 2018 - 07 January 2019 Interventional procedure consultation

For further information on how we develop guidance, please see our page about NICE interventional procedures guidance