What is Transcatheter Mitral Valve Repair (TMVR)

Transcatheter mitral valve repair is a type of surgery to fix problems with the mitral valve. This is the valve between the upper chamber (atrium) and the lower chamber (ventricle) on the left side of the heart.

The mitral valve has two flaps—also called leaflets—that open and close so that blood can move from the atrium to the ventricle. The valve only allows blood to flow in one direction.

You may need surgery if the mitral valve is not working properly or has an infection. It may not open far enough, not close all the way, or have other problems.

Transcatheter means the surgery is done using a long, thin tube (catheter) to reach the valve, instead of traditional open heart surgery. The valve is repaired by placing a device (clip) onto the diseased valve. The device improves the blood flow through the valve and prevents leakage.

Tell a health care provider about:

• Any allergies you have.
• All medicines you are taking, including vitamins, herbs, eye drops, creams, and over-the-counter medicines.
• Any problems you or family members have had with anesthetic medicines.
• Any blood disorders you have.
• Any surgeries you have had.
• Any medical conditions you have.
• Whether you are pregnant or may be pregnant.

What are the risks?

Generally, this is a safe procedure. However, problems may occur, including:

• Infection.
• Bleeding.
• Allergic reactions to medicines or dyes.
• Damage to other structures or organs.
• Blood clots.
• Breathing problems.
• Heart attack.
• Stroke.
• Kidney problems.
• Irregular heartbeat.
• The device failing or not working properly.
• Needing another procedure to close a hole created in the heart to reach the mitral valve.

What happens before the procedure?

Staying hydrated

Follow instructions from your health care provider about hydration, which may include:

• Up to 2 hours before the procedure – you may continue to drink clear liquids, such as water, clear fruit juice, black coffee, and plain tea.

Eating and drinking restrictions

Follow instructions from your health care provider about eating and drinking, which may include:

• 8 hours before the procedure – stop eating heavy meals or foods such as meat, fried foods, or fatty foods.
• 6 hours before the procedure – stop eating light meals or foods, such as toast or cereal.
• 6 hours before the procedure – stop drinking milk or drinks that contain milk.
• 2 hours before the procedure – stop drinking clear liquids.

Medicines

• Ask your health care provider about:
  • Changing or stopping your regular medicines. This is especially important if you are taking diabetes medicines or blood thinners.
  • Taking medicines such as aspirin and ibuprofen. These medicines can thin your blood. Do not take these medicines unless your health care provider tells you to take them.
  • Taking over-the-counter medicines, vitamins, herbs, and supplements.
• You may be given antibiotic medicine to help prevent infection.

General instructions

• Do not use any products that contain nicotine or tobacco, such as cigarettes and e-cigarettes. If you need help quitting, ask your health care provider.
• Ask your health care provider how your surgical site will be marked or identified.
• You may be asked to shower with a germ-killing soap.
• Plan to have someone take you home from the hospital or clinic.
• Plan to have a responsible adult care for you for at least 24 hours after you leave the hospital or clinic. This is important.

What happens during the procedure?

• To lower your risk of infection:
  • Your health care team will wash or sanitize their hands.
  • Hair may be removed from the surgical access site.
  • Your skin will be washed with soap.
• An IV will be inserted into one of your veins.
• You will be given one or more of the following:
  • A medicine to help you relax (sedative).
  • A medicine to make you fall asleep (general anesthetic).
• You will have a breathing tube inserted in your throat to help you breathe. It will be connected to a machine (ventilator).
• An incision will be made in your groin area.
• You may get an injection of X-ray dye so X-rays can be used to guide the surgery.
• A heart ultrasound (echocardiogram) will be used to help guide the surgery. An ultrasound will use sound waves to create a picture of the heart.
• A guide wire will be put through the incision into a vein. It will be threaded up to your heart to reach the mitral valve.
• A catheter will be put over the guide wire through the vein. It will be moved up to your heart to reach the mitral valve.
• The guide wire will be removed.
• A metal clip, ring, or other device will be moved through the catheter into your heart. It will be used to reshape the valve, fix holes or tears, or fix the flaps. The clip, ring, or device will stay in your heart.
• The catheter will be removed.
• Your breathing tube and ventilator may need to stay in place while you recover, or they may be removed in the surgery room. This will depend on how well you are breathing.
• A catheter may be placed to drain urine from your bladder (urinary catheter).
• Small stitches (sutures) will be used to close the incision.
• A bandage (dressing) may be used to cover the incision.

The procedure may vary among health care providers and hospitals.

What happens after the procedure?

• Your blood pressure, heart rate, breathing rate, and blood oxygen level will be monitored until the medicines you were given have worn off.
• You may be given medicine for pain.
• You may continue to receive fluids through an IV.
• You may need to keep using a breathing tube and ventilator.
• Do not drive for 24 hours if you were given a sedative during your procedure.

Summary

• Transcatheter mitral valve repair is a type of surgery that involves placing a device (clip) to fix the mitral valve in your heart.
• Follow instructions from your health care provider about eating and drinking before the procedure.

Transcatheter Mitral Valve Repair, Care After

This sheet gives you information about how to care for yourself after your procedure. Your health care provider may also give you more specific instructions. If you have problems or questions, contact your health care provider.

What can I expect after the procedure?

After the procedure, it is common to have:

• Mild pain or soreness at your incision site.
• Tiredness (fatigue).

Follow these instructions at home:

Incision care

• Follow instructions from your health care provider about how to take care of your incision. Make sure you:
  • Wash your hands with soap and water before you change your bandage (dressing). If soap and water are not available, use hand sanitizer.
  • Change your dressing as told by your health care provider.
  • Leave stitches (sutures), skin glue, or adhesive strips in place. These skin closures may need to stay in place for 2 weeks or longer. If adhesive strip edges start to loosen and curl up, you may trim the loose edges. Do not remove adhesive strips completely unless your health care provider tells you to do that.
• Check your incision area every day for signs of infection. Check for:
  • Redness, swelling, or pain.
  • Fluid or blood.
  • Warmth.
  • Pus or a bad smell.
  • A lump or bump.

Activity

• Do not lift anything that is heavier than 10 lb (4.5 kg), or the limit that you are told, until your health care provider says that it is safe. This is typically 2 weeks.
• Avoid activities that take a lot of effort, such as exercise or sports, as told by your health care provider.
• Avoid sexual activity until your health care provider says that it is safe.
• Return to your normal activities as told by your health care provider. Ask your health care provider what activities are safe for you.

Medicines

• Take over-the-counter and prescription medicines only as told by your health care provider. You may be prescribed a blood thinning medicine if you were not already on one.
• If you were prescribed an antibiotic medicine, take it as told by your health care provider. Do not stop taking the antibiotic even if you start to feel better.
• Do not drive or use heavy machinery while taking prescription pain medicine.

General instructions

• Do not take baths, swim, shower, or use a hot tub until your health care provider approves. Ask your health care provider if you may take sponge baths.
• Do not use any products that contain nicotine or tobacco, such as cigarettes and e-cigarettes. If you need help quitting, ask your health care provider.
• Avoid drinking alcohol.
• Drink enough fluid to keep your urine pale yellow.
• Follow instructions from your health care provider about other eating or drinking restrictions. To prevent heart problems, you may need to follow a low-salt (low-sodium), low-fat diet.
• Weigh yourself daily and monitor your weight for any changes.
• Keep all follow-up visits as told by your health care provider. This is important.

Contact a health care provider if:

• You have a fever.
• You have severe pain, and medicines do not help.
• You have redness, swelling, or pain in your incision area.
• You have fluid or blood coming from your incision.
• Your incision feels warm to the touch.
• You have pus or a bad smell coming from your incision area.
• You develop a lump or bump at your incision area.
• You have a sudden change in your weight.
• You feel abnormal heartbeats.

Get help right away if:

• You have chest pain.
• You have problems breathing.
• You are dizzy or you faint.
• You have any symptoms of a stroke. “BE FAST” is an easy way to remember the main warning signs of a stroke:
  • B – Balance. Signs are dizziness, sudden trouble walking, or loss of balance.
  • E – Eyes. Signs are trouble seeing or a sudden change in vision.
  • F – Face. Signs are sudden weakness or numbness of the face, or the face or eyelid drooping on one side.
  • A – Arms. Signs are weakness or numbness in an arm. This happens suddenly and usually on one side of the body.
  • S – Speech. Signs are sudden trouble speaking, slurred speech, or trouble understanding what people say.
  • T – Time. Time to call emergency services. Write down what time symptoms started.
• You have other signs of a stroke, such as:
  • A sudden, severe headache with no known cause.
  • Nausea or vomiting.
  • Seizure.

Summary

• After the procedure, it is common to have mild pain and soreness at your incision site.
• Check your incision area every day for signs of infection.
• Take over-the-counter and prescription medicines only as told by your health care provider.