Transcatheter mitral valve replacement (TMVR)

The mitral valve controls blood flow between the upper left heart chamber (atrium) and the lower left heart chamber (ventricle). The most common conditions that result in a mitral valve that fails to function properly are:

• Mitral valve regurgitation, a leaky mitral valve, which can cause irregular heart rhythms or heart failure.
• Mitral valve stenosis, a narrowed mitral valve, which can cause pressure buildup in the left atrium.

TMVR is a minimally invasive structural heart disease treatment to replace a damaged mitral valve without open-heart surgery. A flexible, hollow tube (catheter) is inserted through a blood vessel to reach the heart and replace the mitral valve. There are two types of TMVR techniques:

• Native valve replacement: We use this investigational technique to replace your original mitral valve.
• Valve-in-valve: We place a new valve to treat a failing ring (small, mesh band that reinforces the mitral valve) from a prior surgery or to replace a failing prosthetic replacement valve.

Transcatheter mitral valve replacement may be appropriate for patients with mitral valve regurgitation or mitral valve stenosis but aren’t good candidates for open-chest mitral valve repair and replacement surgery. Older people and those with underlying health conditions have higher risks of open-chest surgery and may be better candidates for TMVR.

TMVR is an inpatient procedure that takes two to three hours. You receive anesthesia to keep you comfortable. The TMVR team includes an interventional cardiologist, an interventional echocardiographic, and an anesthesia specialist.

When it’s time for the procedure, the team connects you to an electrocardiogram machine that monitors your heart’s electrical activity. You also are connected to machines that record your heart rate, breathing, oxygen levels, and blood pressure.

During the TMVR procedure, your doctor:

1. Makes a tiny incision in your groin and inserts a flexible, hollow tube (catheter) into a blood vessel
2. Uses imaging guidance to thread the catheter to your mitral valve
3. Sends a compressed mitral valve through the catheter
4. Positions the new valve inside your natural mitral valve or the damaged prosthetic valve
5. Expands the new valve to secure it in place

In the past, the only option to replace a leaky or narrowed mitral valve required open-heart surgery. This technique involves opening the chest and breastbone with a large incision. Open-heart surgeries are typically more painful with a longer recovery time and greater risks. Open-heart surgery is also not an option for people with certain underlying health conditions.

Transcatheter mitral valve replacement allows mitral valve replacement without opening your chest, offering treatment to people who are not candidates for open-heart surgery.

Our team closely monitors you after TMVR. You may spend one night in the intensive care unit (ICU) while you recover. In total, you can expect to spend around three to five days in the hospital.

Most people experience an immediate improvement in mitral valve disease symptoms after TMVR. Your recovery time after TMVR depends on several factors, including your overall health. TMVR has a significantly shorter recovery period than open-heart surgery. It’s important to take all medications prescribed by your doctor and follow any other recommendations during recovery

Your provider may advise participating in cardiac rehabilitation after a mitral valve replacement. Cardiac rehab can help strengthen your heart, speed your recovery, and reduce your risk of future heart problems. Our specialists provide exercise guidance, nutrition counseling, and heart health education in an outpatient setting.