MitraClip Transcatheter Mitral Valve Replacement (TMVR) Procedure
TMVR is different from open heart surgery in that it is a less invasive approach to treat a diseased valve. The TMVR team will determine the best approach once the patient's entire evaluation is completed.
The MitraClip device is a small clip that is attached to the mitral valve. By allowing the valve to close more completely, the clip helps restore normal blood flow through the heart.
Depending on the patient's health and the amount of clips needed, the average time of the procedure is three to four hours.
The procedure is done under general anesthesia. An anesthesiologist will monitor the patient's vital functions and breathing throughout the entire process.
As with any medical procedure, there are risks. Although this is a lower risk procedure, it does not mean there is no risk. The risks of TMVR include: bleeding, vascular complications, stroke, kidney failure and even death.
Mitral regurgitation is a diagnosis that requires the Heart Valve Team to perform a comprehensive exam and obtain pertinent tests in order to get a complete understanding of how this disease process has impacted the patient's quality of life and overall health.
A typical outline of the evaluation process to confirm whether someone is a candidate for TMVR is includes the following steps:
- Transesophageal Echocardiogram
- This ultrasound of the heart is usually the first study done in determining mitral regurgitation. A physician will insert a probe down the esophagus in order to get clear images of the heart. A medication will be given to make the patient comfortable during this procedure.
- Cardiac Catheterization (Angiogram)
- Cardiac catheterization, or angiogram, allows cardiologists to evaluate the arteries, assess pressures within the heart chambers and measure the severity of the mitral regurgitation.
- Cardiac Surgery Consultation
- Currently, TMVR is only approved for patients who meet a certain risk criteria. In order to qualify for TMVR, the patient must be deemed a high surgical risk patient. Our cardiothoracic surgeon will evaluate the overall individual risk to successfully undergo surgical mitral valve replacement or repair.
- Additional Testing/Consults
- Occasionally the Heart Valve Team will determine that it is necessary to obtain additional testing or additional review by other physicians based on symptoms and medical history.
- Heart Valve Team Review
- After completing all components of evaluation, the patient's case will be discussed at a collaborative valve conference meeting. At this meeting the team will review all diagnostic data and confirm a treatment plan that is best suited for a patient's needs. This plan is communicated back to the patient and loved ones for discussion to make a decision about next steps.
A small incision is made in the upper leg. The doctor will insert a long, hollow tube called a sheath into the femoral vein and guide it to the heart. The clip device is controlled by a delivery system that remains outside the body.
The delivery system carrying the clip is advanced to the right side of the heart and then across to the left side of the heart; this is known as a trans-septal puncture. The clip is then positioned over the leaky mitral valve. The physicians use a transesophageal echocardiogram to visualize the valve and correctly position clip device. Once the clip attaches to both sides of the leaky valve, the physicians will close the clip, bringing the mitral valve leaflets together and reducing the backflow of blood. Measurements are taken with the ultrasound to ensure the clip is functioning properly. The physicians will then determine the need for additional clips before removing the delivery system and closing the incision in the leg.
Typically patients stay in the hospital one to two days after their TMVR and are discharged home after an evaluation by the doctor.
Some patients feel immediate relief from their symptoms soon after their TMVR procedure, but it is very common to take a little longer to get back to normal.
There is research that shows patients who undergo TMVR have a reduction in hospital admissions, improvement of heart failure symptoms, and an increase in quality of life.
Most patients are able to return to work within two weeks after the procedure. This should be discussed with the doctor to determine when it is safe. Most patients return to day-to-day activities within a few days after the procedure.
For most people, limitations after TMVR include no heavy lifting of more than five to 10 pounds for one week. Patients may not drive for a week and should not submerge the incision sites in water, such as a bathtub, swimming pool or hot tub. Showering is allowed. We highly encourage patients to participate in outpatient cardiovascular rehabilitation. This program safely assists with increasing physical activity and assisting with risk reduction, medication and nutrition education. The physician can refer patients to the Tamkin Cardiac Wellness Program after the post-operative office visit.
A patient's medication regimen may change based on individualized needs during the hospital stay. After the TMVR procedure, patients will need to take antibiotics prior to any dental cleaning or procedures to prevent against infection of the heart valve.
Patients should have a follow up appointment arranged a week after the procedure. Within 30 days of the procedure, patients should have an echocardiogram, then yearly after that with a cardiologist.
It is important to follow up with a cardiologist and primary care physician in between these appointments.