Transcatheter Mitral Valve Repair (TMVR)

Transcatheter mitral valve repair (TMVR) is a minimally invasive procedure designed to correct a leaky mitral valve without the need for open-heart surgery. A leaky valve refers to a heart valve that’s not closing properly.

The mitral valve is one of the heart's four valves; it's located between the left atrium and the left ventricle. The mitral valve’s crucial role is to ensure that blood flows in one direction, from the left atrium into the left ventricle, and prevents it from flowing backward — a condition known as mitral regurgitation or MR — when the left ventricle contracts.

To fully understand the TMVR procedure, it’s helpful to know more about mitral regurgitation (MR). MR occurs when the mitral valve doesn't close properly, allowing blood to flow backward into the left atrium during ventricular contraction. This makes the heart work harder to pump the same amount of blood forward, leading to:

• Increased pressure in the left atrium and pulmonary veins.
• Enlargement of the left atrium and left ventricle over time.
• Symptoms like shortness of breath, fatigue, swelling, and reduced exercise tolerance.

Ultimately, if left untreated, it can lead to heart failure and other severe complications.

Why choose AHN

If you require a transcatheter mitral valve repair procedure, getting care from a highly experienced, specialized team like that at AHN can make all the difference. The renowned cardiologists, surgeons, and heart specialists within the Cardiovascular Institute who have dedicated their lives to treating diseases and conditions of the heart provide patients with tailored care that delivers positive health outcomes.

AHN is committed to delivering advanced care that is proven, personalized, and that uses the latest in technological advancements. At AHN, we see you.

What to expect for a TMVR

Understanding a transcatheter mitral valve repair (TMVR) procedure will help you feel prepared for and confident in this treatment option. Your AHN care team will be available throughout this process to help you and guide you with a personalized plan.

A TMVR is a minimally invasive procedure designed to fix a leaky mitral valve. This is often performed for patients with severe mitral regurgitation who may not be suitable candidates for traditional open-heart surgery.

Prior to the procedure, you will undergo a comprehensive medical exam to ensure you are a good candidate. This preparation often includes:

• Physical exam: The exam will go over your medical history, so your care team can understand your overall health and cardiac condition. You will also undergo a physical exam so your team can get a full view of your health.
• Echocardiogram (Transthoracic and Transesophageal): These imaging tests are vital to assess the severity of mitral regurgitation, the structure of the mitral valve, and to plan the repair strategy. A transesophageal echo (TEE) provides much more detailed images as it's performed from inside the esophagus, closer to the heart.
• CT scan: To evaluate the heart's anatomy, surrounding structures, and access routes for the catheter.
• Blood tests: To check kidney function, blood count, and clotting factors.
• Electrocardiogram (ECG): To assess heart rhythm.
• Medication review: The medical team will review all current medications. Patients may be instructed to stop certain medications, such as blood thinners, for a few days before the procedure, while others may need to be adjusted.

TMVR procedures are performed in a specialized cardiac catheterization lab (often called a cath lab or hybrid operating room) within a hospital. These labs are equipped with advanced imaging technology like fluoroscopy, echocardiography, and sometimes 3D imaging, which allow the cardiologist to precisely guide the instruments.

On the day of the procedure, you will have an opportunity to talk with your care team and ask any final questions. You will then be prepped and sent back to the catheterization lab for the surgery. For the TMVR, you will receive anesthesia. Once you are comfortable and sedated, the cardiologist makes a small incision, usually in the groin, to access the femoral vein. A thin, flexible tube called a catheter is then inserted into this vein.

Using real-time imaging (fluoroscopy and TEE), the catheter is carefully guided through the venous system, up to the heart, and into the right atrium. The catheter is then advanced across the mitral valve into the left ventricle. A specialized repair device (the most common type being the MitraClip^TM, though other devices exist) is delivered through the catheter. The MitraClip^TM device is designed to grasp the mitral valve, reducing the regurgitation (leakage).

Under continuous imaging guidance, the device is positioned and then deployed to clip the mitral valve leaflets together. The medical team will then assess the effectiveness of the repair immediately using echocardiography to ensure the regurgitation is significantly reduced and that there's no obstruction to blood flow.

Once the repair is deemed successful, the catheters are carefully withdrawn. The access site in the groin is then closed, often with a special closure device or manual pressure.

The patient is then moved to a recovery area for close monitoring.

TMVR recovery

Recovery from a transcatheter mitral valve repair (TMVR) is generally much faster and less extensive than recovery from traditional open-heart surgery, but it still requires careful management. Typically, a patient will be in the hospital for one to five days for recovery.

You should expect to feel fatigue initially but will gradually increase activity, carefully following instructions for groin site care and avoiding heavy lifting for several weeks. Taking your prescribed medications and attending follow-up appointments, including potential cardiac rehabilitation, are crucial for optimal healing and regaining full strength and heart health over a few months.

TMVR FAQs

At the AHN cardiovascular institute, we specialize in minimally invasive procedures like TMVR to help our patients return to their lives as soon as possible. Your care team is available to answer your specific questions and help you feel confident in your treatment plan. Many patients have questions about TMVR, so we’ve included some of the most frequently asked to help provide you with additional resources prior to speaking with your care team.

Who is a candidate for transcatheter mitral valve repair?

Candidates for TMVR are primarily individuals with severe symptomatic mitral regurgitation (a leaky mitral valve) who are considered to be at high or prohibitive risk for traditional open-heart surgery. This often includes patients who:

• Have multiple coexisting medical conditions (comorbidities) that make open-heart surgery too dangerous.
• Are elderly or frail.
• Have already had prior open-heart surgery.
• Are experiencing significant symptoms such as shortness of breath, fatigue, or heart failure despite optimal medical therapy.
• Have suitable valve anatomy for the device to be successfully implanted.

The decision is made by a multidisciplinary "Heart Team" consisting of cardiologists, cardiac surgeons, and other specialists, who carefully evaluate the patient's overall health, valve anatomy, and surgical risk.

How long does a TMVR take?

The actual TMVR procedure typically takes between one to three hours. However, this time frame can vary based on the complexity of the patient's anatomy, and the number of clips needed (if using a device like MitraClip^TM). It's important to note that the total time spent in the catheterization lab, including preparation and post-procedure assessment, might be longer.

What is the survival rate for TMVR?

The survival rate for TMVR is generally favorable, especially considering that candidates are often high-risk patients who would not tolerate traditional surgery.

It's crucial to remember that individual outcomes can vary based on the patient's specific health condition, the severity of their heart failure, and other comorbidities (multiple health issues).

Who is not a candidate for TMVR?

While TMVR is a valuable option, it's not suitable for everyone. Patients who are generally not candidates include those with:

• Mitral valve anatomy unsuitable for the device: This could include severely calcified leaflets, very large gaps between the leaflets, or other structural issues that prevent effective clip placement.
• Other significant heart valve disease that requires surgical intervention (e.g., severe aortic valve disease).
• Active infections (like endocarditis) on the valve.
• Extremely low ejection fraction or advanced heart failure where the benefits of the procedure are unlikely to outweigh the risks.
• Good prognosis with traditional open-heart surgery. Patients who are good candidates for traditional open-heart surgery and have a lower surgical risk are generally not considered for TMVR, as surgical repair or replacement may offer a more durable solution for them.
• Lack of suitable venous access (e.g., severe peripheral vascular disease that prevents catheter insertion).

What is the success rate of TMVR?

The success rate of TMVR, often measured by the ability to significantly reduce mitral regurgitation, is quite high.

• Procedural success (meaning the device was implanted successfully and achieved a reduction in MR to mild or moderate levels) is typically reported to be in the range of 90-98%*.
• This immediate reduction in leakiness leads to improved heart function and often a significant improvement in symptoms for the patient.
• The durability of the repair is also good, with a high percentage of patients maintaining a satisfactory reduction in MR at one year and beyond.

It's important to distinguish between procedural success (technical success of implantation and initial reduction of MR) and clinical success (improvement in patient symptoms and quality of life), both of which are generally very positive for appropriate candidates.

Contact us

If you don’t have a diagnosis but suspect you need TMVR, call (412) DOCTORS 412-362-8677 to make an appointment with your primary care physician.

Schedule an evaluation

If you’ve recently been diagnosed, want a second opinion, or are looking for an evaluation, contact one of the structural heart clinics directly to schedule an appointment. An evaluation is needed if you’ve been diagnosed or want a second opinion on whether this treatment is right for you.

We accept films from facilities outside of our network, such as a CT scan and cardiac catheterization, but an echocardiogram must be done by AHN.