Transcatheter Mitral Valve Replacement

Transcatheter Mitral Valve Replacement (TMVR) is a minimally invasive surgical procedure used to replace a damaged or diseased mitral valve with an artificial valve. Unlike traditional open-heart surgery, TMVR is performed using catheters, which are inserted through blood vessels and guided to the heart, avoiding the need for a large incision.

 

Types

There are different types of TMVR procedures, depending on the design and deployment of the artificial valve. The two main types are:

  • Transcatheter Valve-in-Valve (ViV): This procedure involves implanting a new transcatheter valve within a previously placed surgical bioprosthetic valve. It is used when the existing surgical valve begins to fail.
  • Transcatheter Valve-in-Ring (ViR): In this procedure, a new transcatheter valve is implanted within a surgical ring that was previously placed around the native mitral valve.

 

Treatments

TMVR is used to treat mitral valve disease, specifically severe mitral regurgitation or mitral stenosis, where the mitral valve does not close properly or is narrowed, leading to the backward flow of blood or reduced blood flow through the valve. The procedure is necessary when patients are considered at high surgical risk or are not suitable candidates for traditional open-heart surgery.

 

Before the procedure

  • Medical evaluation: Your healthcare team will perform a comprehensive assessment of your overall health, including imaging tests and diagnostic procedures.
  • Medication management: You may be advised to adjust or stop certain medications before the procedure, as directed by your healthcare provider.
  • Fasting: You will be instructed to fast for a specified period before the procedure to ensure an empty stomach.

 

During the procedure

  • Anesthesia: The procedure is typically performed under general anesthesia to ensure you are asleep and pain-free throughout.
  • Catheter insertion: A catheter is inserted into a blood vessel, usually in the groin or leg, and guided to the heart using imaging techniques.
  • Valve placement: The transcatheter valve is advanced through the catheter and positioned within the diseased mitral valve. Once in place, the artificial valve is deployed, taking over the function of the native valve.
  • Evaluation and adjustments: The valve’s position and function are evaluated using imaging, and adjustments may be made to ensure proper placement and function.

 

After the procedure

  • Recovery: You will be closely monitored in a recovery area until you are stable. The length of hospital stay may vary, but it is generally shorter than with open-heart surgery.
  • Follow-up care: Regular follow-up appointments will be scheduled to monitor your progress, evaluate valve function, and make adjustments to medications if necessary.

 

Advantages

  • Minimally invasive: TMVR is a less invasive alternative to traditional open-heart surgery, leading to reduced pain, shorter hospital stays, and faster recovery.
  • Suitable for high-risk patients: TMVR offers a treatment option for patients who are considered at high surgical risk or are not eligible for open-heart surgery.
  • Improved valve function: The procedure can significantly improve mitral valve function, reducing symptoms and improving quality of life.

 

Risks

While TMVR is generally considered safe, there are potential risks and complications, including:

  • Valve misplacement or migration
  • Valve leak or dysfunction
  • Blood vessel damage or bleeding
  • Infection
  • Heart rhythm abnormalities
  • Allergic reactions to anesthesia or contrast agents

 

Typical recovery time

The recovery period after TMVR is typically shorter than that of open-heart surgery. Most patients can resume normal activities within a few days to weeks, depending on individual healing and the extent of the procedure.

 

Results and post-procedure care

Following transcatheter mitral valve replacement, you may be advised to:

  • Take prescribed medications, such as antibiotics or anti-inflammatory drugs, as directed.
  • Follow up with your healthcare provider for further evaluation and management of the underlying condition.
  • Monitor for any signs of complications, such as increased pain, swelling, redness, fever, or difficulty breathing, and promptly report them to your healthcare provider.