Transcatheter Mitral Valve Replacement (TMVR)

Overview

Transcatheter mitral valve replacement (TMVR) is a surgical procedure that replaces the heart’s mitral valve. Patients with mitral valve disease can choose this less invasive option instead of open heart surgery.

The old valve is replaced by a manufactured (human-made) valve or one created from biological heart tissue from a pig, cow, or human. The malfunctioning mitral valve will be replaced by the new valve.

Reasons for undergoing the procedure

One of the four heart valves that maintains blood flow in the proper direction is the mitral valve. The left ventricle (chamber on the bottom left) and left atrium (chamber on the top left) of the heart are separated by the mitral valve. When it works properly, its two leaflets, which are flaps that open and close with each heartbeat, allow blood to flow forward in a single direction.

Some may have issues with their mitral valve from birth or develop them later on. These issues include:

• Mitral valve regurgitation: The inability of the mitral valve to seal completely can result in regurgitation, which is the backflow of blood.
• Mitral valve stenosis: A condition known as mitral valve stenosis occurs when the valve narrows or becomes clogged, limiting the amount of blood that can flow forward.

If open heart surgery is not a good option for a patient with mitral valve disease, TMVR may be an alternative.

Risk

Despite the fact that the transcatheter technique carries lower risks than open-heart surgery, certain issues can arise, such as:

• Blood clots
• Tissue damage, such as a coronary artery injury or a left ventricular perforation.
• Stroke
• Obstruction of the left ventricular outflow tract, which prevents blood flow from the left ventricle.
• The valve migrating or moving out of position.

If an open-heart surgery is required, the heart team may decide to switch up the process. A second procedure can be necessary for certain complicaions.

Before the procedure

The healthcare providers will do procedures like a CT scan and echocardiography before to TMVR. The team uses the tests to assist plan the process.

The patient will also consult with the healthcare provider to ascertain the most appropriate anesthetic type to avoid pain throughout the surgery. There are alternatives like conscious sedation or general anesthesia.

The patient will receive detailed instructions on how to get ready for the TMVR from the healthcare provider. Among them could be:

• Patient should arrange with someone to bring them home after the procedure.
• A few days prior to the surgery, stop taking specific medications.
• Avoid any food and water intake on the day of the procedure

During the procedure

It calls for a multidisciplinary team of experts, including anesthesiologists, cardiac surgeons, interventional cardiologists, and imaging specialists. The team will perform the following:

• Prepare the area for the treatment by shaving and cleaning it.
• To administer medicine and fluids, insert a soft, flexible tube, known as an intravenous line or IV, into an arm vein.
• Attach the manufactured valve to the end of the catheter, which is a thin, flexible tube.
• Create an incision in the chest or groin, and then introduce the catheter into a blood vessel.
• The catheter can be guided to the mitral valve by using imaging devices.
• Install the new valve within the one that already exists.
• Securing the new valve in place.
• Close the incision after removing the catheter.

It will take two to three hours to complete the process.

The healthcare providers continuously check the patient’s vital signs, such as blood pressure and oxygen saturation levels, throughout the treatment. Echocardiography, which produces images of the heart’s chambers and valves, is another tool they use to monitor the heart.

After the procedure

The patient will be transferred to the recovery room after TMVR, where they will be observed by the medical team until the anesthesia wears off. Most patients stay in the hospital for a few days, however some may only need to visit the intensive care unit (ICU) for a brief period of time.

The following specific instructions will be given to the patient by the healthcare providers:

• Cardiac rehabilitation.
• Start with the new medication or continue the current medications.
• Discuss regarding the follow-up visit with the healthcare provider.
• The healthcare provider will discuss if when can the patient go back to work or to their daily activities.

Outcome

There are several advantages to heart valve surgery using the transcatheter method. It can treat mitral valve disease, easing symptoms and lowering the possibility of serious health problems. Furthermore, this approach offers a quicker recovery than conventional open-heart surgery options.

In the event that the patient has mitral valve replacement, seek immediate medical attention if the patient see any of the following stroke symptoms:

• Weakness or loss of movement in their arms, legs, or face, typically on one side of their body.
• Numbness or tingling.
• Having problem in speaking.
• Difficulties in walking or keeping a steady balance.
• Sudden disorientation or difficulty comprehending people.
• Sudden, severe headache.
• Visual change.

In addition, seek emergency medical attention if the patient exhibits any of the following heart attack symptoms:

• Chest pain.
• Pressure or pain in the arm, shoulder, belly, back, neck, or jaw.
• Difficulty in breathing.
• Weakness, fainting, or light-headedness.
• Nausea and vomiting.

There are several issues for calling the healthcare provider:

• Issues with incisions, like loose stitches or bleeding from the incision.
• Pain, swelling, or discoloration in the groin, thigh, calf, or knee; these symptoms could be signs of a blood clot.
• Any sign of infection such as fever, pus, fluid drainage, discolored streaks at the skin, or pain.
• A sudden increase in weight or swelling in the feet, ankles, or legs, which could indicate heart failure