Percutaneous Mitral Valve Repair

Percutaneous mitral valve repair, also known as transcatheter mitral valve replacement (TMVR), is a minimally invasive procedure used to treat certain conditions affecting the mitral valve, which is located between the left atrium and the left ventricle of the heart. It involves repairing the valve without the need for open-heart surgery. TMVR is typically performed using a catheter-based approach, where specialized tools are guided through blood vessels to the heart. Repairing the mitral valve can restore its proper function and help prevent blood leakage (mitral regurgitation) or narrowing (mitral stenosis).

 

Treatments

Percutaneous mitral valve repair surgery is the preferred treatment for mitral valve conditions such as mitral valve prolapse, mitral regurgitation, or certain cases of mitral stenosis.

There are different techniques for percutaneous mitral valve repair, but the most common one is the MitraClip system. The MitraClip is a small device consisting of a clip that is used to grasp and close the mitral valve leaflets, reducing the severity of mitral regurgitation (leakage of blood backward through the valve). Other techniques under investigation include transcatheter annuloplasty and chordal repair.

 

Before the procedure

Before undergoing mitral valve repair surgery, a thorough evaluation is conducted to assess the patient’s overall health and determine the suitability for the procedure.

Preparing for percutaneous mitral valve repair may include:

  • Medical evaluation, including imaging tests and blood work.
  • Discussion with your healthcare team about the procedure, potential risks, and benefits.
  • Temporary discontinuation or adjustment of certain medications, as advised by your doctor.
  • Fasting for a specific period before the procedure.
  • Arranging transportation to and from the hospital.

 

During the procedure

The specific technique used during mitral valve repair surgery may vary depending on the patient’s condition and the surgeon’s preference. However, the general steps involved in the procedure include:

  • Anesthesia: The patient is placed under general anesthesia to ensure they are unconscious and pain-free throughout the procedure.
  • Incision: A surgical incision is made in the chest, typically through a sternotomy (midline incision) or a smaller incision in the chest wall (minimally invasive approach).
  • Accessing the Heart: The surgeon gains access to the heart and locates the mitral valve.
  • Repairing the Valve: The surgeon performs various techniques to repair the mitral valve, which may include resizing, reshaping, or reinforcing the valve leaflets, repairing the supporting structures (chordae tendineae and papillary muscles), or removing excess tissue.
  • Assessment and Testing: Once the repair is completed, the surgeon tests the valve’s function and ensures proper closure without significant leakage.
  • Closure: After confirming the successful repair, the surgical incision is closed using sutures or staples.

 

After the procedure

After percutaneous mitral valve repair surgery, the patient is transferred to the recovery area and closely monitored. The vital signs, heart function, and oxygenation are continuously assessed. Pain management, medication administration, and fluid balance are carefully monitored and adjusted as needed. The patient may require temporary ventilation support and is gradually weaned off the ventilator.

 

Advantages

  • Preserves Natural Valve: Mitral valve repair aims to preserve the patient’s natural valve, which is associated with better long-term outcomes compared to valve replacement.
  • Improved Valve Function: Repairing the mitral valve restores its normal function, allowing for better blood flow and reducing the risk of complications such as blood leakage.
  • Reduced Long-Term Medication Needs: Unlike valve replacement, mitral valve repair usually does not require long-term anticoagulation therapy, reducing the reliance on blood-thinning medications.

 

Risks

Percutaneous mitral valve repair surgery, like any surgical procedure, carries certain risks and complications, which may include:

  • Bleeding: There is a risk of bleeding during or after the procedure, which may require blood transfusions or further intervention.
  • Infection: Infection at the incision site or within the chest cavity is a potential complication, which may require antibiotics or additional treatments.
  • Valve-related Issues: Although repair techniques aim to restore proper valve function, there is a small risk of recurrent valve dysfunction or the need for further interventions in the future.

 

Typical recovery time

The recovery time after percutaneous mitral valve repair surgery can vary depending on individual factors including the patient’s overall health, age, and the specific technique used. However, in general, patients can expect to stay in the hospital for a few days to a week after the surgery. The complete recovery period may take several weeks to a few months, during which the patient gradually resumes normal activities under the guidance of the healthcare team.

 

Results and post-procedure care

Percutaneous mitral valve repair surgery has shown excellent outcomes in terms of restoring valve function, improving symptoms, and long-term survival rates. Following the procedure, post-procedure care may include:

  • Regular follow-up appointments with the healthcare team to monitor the repaired valve’s function, overall cardiac health, and recovery progress.
  • Medication adherence, including prescribed medications to manage blood pressure, prevent infection, or maintain heart function.
  • Cardiac rehabilitation programs to gradually increase physical activity and improve cardiovascular fitness.
  • Close monitoring for any signs of recurrent valve dysfunction, abnormal symptoms, or complications and seeking immediate medical attention if any concerns arise.