Transcatheter Mitral Valve Replacement (TMVR)

What is a TMVR procedure?

Transcatheter mitral valve replacement (TMVR) is a procedure to replace the mitral valve in your heart. It’s a less invasive alternative to open-heart surgery for people with mitral valve disease.

TMVR implants a manufactured (human-made) valve or one made from cow, pig or human biological heart tissue in the position of the old valve. The new valve then does the work of the faulty mitral valve.

Who needs to have transcatheter mitral valve replacement?

Your mitral valve is one of four heart valves that keep blood flowing in the correct direction. Your mitral valve exists between the two left chambers of your heart, the left atrium (chamber on the top left) and left ventricle (chamber on the bottom left). It has two flaps called leaflets that open and close during every heartbeat and when functioning properly, facilitate one-way direction of forward blood flow.

Sometimes, people are born with or develop problems with their mitral valve, such as:

• Mitral valve regurgitation, when the valve doesn’t close properly and can let blood leak backward.
• Mitral valve stenosis, when the valve narrows or becomes blocked and doesn’t open as wide as it should, preventing adequate forward blood flow.

Severe cases of mitral valve disease can cause symptoms, including atrial fibrillation, pulmonary hypertension or heart failure.

TMVR is an option for some people with mitral valve disease who aren’t good candidates for open-heart surgery.

Is TMVR the same as MitraClip?

Cardiologists use several minimally invasive methods to treat mitral valve disease. Some procedures replace the mitral valve while others repair it. MitraClip™ is a type of repair technique. TMVR replaces a defective valve.

What happens before the TMVR procedure?

Before TMVR, your healthcare team will conduct tests such as an echocardiogram and CT scan. The tests help the team plan the procedure.

You’ll also meet with a specialist to determine what type of anesthesia is best to prevent pain during the procedure. Options may include general anesthesia or conscious sedation.

Your healthcare provider will give you specific instructions on how to prepare for TMVR. They may include:

• Stop taking certain medications a few days before the procedure.
• Avoid food and water on the day of the procedure.
• Arrange for a ride home after the procedure.

What happens during TMVR?

TMVR takes about two to three hours. It requires a team of specialists, including cardiac surgeons, interventional cardiologists, imaging specialists and anesthesiologists. The team will:

1. Shave and clean the area where the procedure will take place.
2. Insert a soft, flexible tube (intravenous line or IV) into a vein in your arm to deliver medications and fluids.
3. Place the human-made valve onto the end of a catheter (thin, flexible tube).
4. Make an incision in your groin or chest, then insert the catheter into a blood vessel.
5. Use imaging technology to guide the catheter to your mitral valve.
6. Position the new valve inside the existing valve.
7. Secure the valve in place.
8. Remove the catheter and close the incision.

During the procedure, your healthcare providers continuously monitor your vital signs, including blood pressure and blood oxygen levels. They also monitor your heart with echocardiography, which provides pictures of the valves and chambers.

What happens after TMVR?

After TMVR, you go to a recovery room where your healthcare team monitors you as the anesthesia wears off. Some people may need to stay in the intensive care unit (ICU) for a short while, and most people spend a few days in the hospital.

Your healthcare providers will give you specific instructions about:

• Cardiac rehabilitation.
• Follow-up appointments.
• Starting or restarting medications.
• When you can go back to work or your usual daily activities.

What are the advantages of TMVR?

The transcatheter approach to heart valve surgery can:

• Correct mitral valve disease.
• Improve symptoms caused by mitral valve disease.
• Decrease the risk of serious health problems.
• Provide a quicker recovery than open-heart surgical options.

What are the risks or complications of TMVR?

Although the transcatheter approach has fewer risks than open-heart surgery, complications may occur, including:

• Blood clots, which can cause a stroke.
• Damage to tissues, such as left ventricular perforation (tear) or injury to a coronary artery.
• Left ventricular outflow tract obstruction, which interferes with blood flow from your left ventricle.
• Movement or migration of the valve out of position.

The heart team may decide to change the procedure to an open-heart surgery if necessary. Some complications may require a second procedure.

What is the recovery time after TMVR?

Many people go back to work and other activities several weeks after TMVR. But full recovery may take two to three months. Be sure to follow your healthcare provider’s instructions before resuming any activities.

When should I seek medical attention after a transcatheter mitral valve replacement procedure?

If you’ve had a mitral valve replacement, seek immediate medical attention for signs of a stroke, such as:

• Changes in vision.
• Numbness, tingling, weakness or loss of ability to move your face, arms or legs, especially on one side of your body.
• Problems walking or maintaining balance.
• Sudden confusion or trouble understanding others.
• Sudden, severe headache.
• Trouble talking.

Also, seek emergency medical care if you have signs of a heart attack, which include:

• Chest pain.
• Light-headedness, weakness or fainting.
• Nausea and vomiting.
• Pain or pressure in your back, neck, jaw, belly, shoulder or arm.
• Shortness of breath.

Other reasons to call your healthcare provider include:

• Incision problems, such as loose stitches or bleeding from the wound.
• Pain, discoloration (red, purple, dark brown or black) or swelling in your calf, knee, thigh or groin, which may indicate a blood clot.
• Signs of infection, such as pain, fever, pus, fluid drainage or discolored streaks on your skin.
• Sudden weight gain or swelling in your legs, ankles or feet, which may be a sign of heart failure.

A note from Cleveland Clinic

Transcatheter mitral valve replacement (TMVR) is a procedure to replace a person’s mitral valve. It’s a less invasive option than open-heart surgery for certain people with mitral valve disease. Talk to your healthcare provider about which type of repair or replacement technique is right for you.