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Transcatheter Mitral Valve Repair (TMVR) with MitraClip

Transcatheter mitral valve repair (TMVR) is a minimally invasive procedure to treat severe mitral valve leakage with the device called the MitraClip.

Benefits

Treatment with MitraClip is an option for patients with symptoms of severe mitral valve leakage that are not eligible for open heart surgery or patients who are considered high-risk for surgery, such as the elderly and those with multiple medical conditions. This procedure improves the quality of life as it decreases the risk of death. Furthermore, it reduces the symptoms of the mitral valve leakage and improves general health. A cardiologist and a cardiac surgeon will consider whether transcatheter mitral valve repair (TMVR) is appropriate for you.

Your health and the severity of the disease must be assessed before the procedure. You will also be given all relevant information regarding your treatment plan to ensure highest effectiveness. Your cardiologist and cardiac surgeon will explain your condition to you, the reasons for the surgery, and the risks and benefits of the procedure. There are also standard pre-operative procedures as follows:

1.    Before the procedure you will undergo a thorough health screening that will include an echocardiography and a transesophageal echocardiogram to ensure the safest, most accurate, and most effective treatment.

2.    If you or your family have a history of abnormal bleeding or existing bruising over your/their body, please let the doctor know.

3.    Please let your medical team know about any allergies you have to medicine, food, and other substances. Please also let the team know if you had or have any implanted electronic device in your body.

4.    Please stop taking certain medications for five to seven days before the procedure, such as anticoagulants, and other medication as recommended by your doctor.

5.    Please fast for at least eight hours before the procedure.

6.    Please stop drinking alcohol and smoking cigarettes at least one week before the procedure.

7.    Bring all your current medication to the hospital with you when you arrive for the procedure.

 
Transcatheter mitral valve repair (TMVR) involves the use of the MitraClip to close the space between the leaky mitral valve. The procedure is done in a Cardiac Catheterization Laboratory. During the procedure, transesophageal echocardiography will be used with high-level x-ray to ensure accuracy and the best results when placing the clip. Normally, one to three clips are enough to significantly decrease mitral regurgitation and improve the heart’s muscle function. It is a safe procedure with minimal complications.

The procedure is done under general anesthesia which means you will be asleep during the entire procedure. The cardiologist will insert a catheter into the heart through the femoral vein at the groin and thread it to the affected mitral valve. When the procedure is completed, the catheter will be removed and, if you were intubated, the breathing tube will be removed as well. The procedure takes approximately two to three hours.
 
  1. You will stay in the hospital for three to five days with the first one to two days in the Cardiac Care Unit where your heart rhythm and rate, blood pressure, body temperature, and respiration rate will be monitored.
  2. When you are conscious you can begin a rehabilitation program by doing small exercises: opening and closing your hands and pointing and flexing your toes to stimulate circulation.
  3. Patients normally experience pain at the insertion site, especially in the first 48-72 hours after the procedure. Pain medication will be prescribed to manage this.
  4. As your condition improves, the doctor will gradually remove monitoring equipment, as appropriate.
  5. When the breathing tube is removed, if you have any mucus, you must cough it out to prevent pneumonia. Take deep breaths every hour to prevent the lungs from collapsing.
  6. After the procedure you must lie flat with your legs extended for four to six hours to prevent bleeding where the catheter was inserted. It is normal to see some bruising at the insertion site.
  7. When it is safe for you, your doctor will allow you to first drink water and then eat food.
  8. When your doctor decides it is appropriate, you will be moved to an inpatient room for another two to three days to continue your rehabilitation with walking and exercise, after which you will be able to return home.
  9. Before you are discharged, your doctor will make follow-up appointments to continue monitoring your health.
After the procedure you may feel fatigued and can resume normal activities after two to four weeks. At your follow-up appointment, your doctor will perform a physical examination and check your incision. You will receive your procedure report and other relevant documents.
  • Activity. Avoid strenuous activity that involves pulling, pushing, or lifting, driving, and kneeling for at least one to two weeks as these can affect how the would heals.
  • Wound care. When you are allowed to shower, be sure to do so daily with soap. Pat your incision dry and keep the area clean always. Avoid applying any lotions, creams, or powder to the incision until it is fully healed. Please contact your doctor if you have a fever, if the incision looks inflamed or swollen, if pain worsens, or if there is fluid leaking from the wound.
  • Diet. Eat healthy foods, particularly food necessary to manage the disease. Eat a balanced diet and avoid foods that are too salty or fatty. Avoid foods that raise blood sugar.
  • Exercise. Before you are discharged, you will be given instructions on exercising at home. In the first month after the procedure you must only walk for exercise. Please carefully follow the instructions of your doctor and cardiac rehabilitation team.
  • Appointments. Please come to all follow-up appointments to monitor your symptoms and check how your wound is healing. If you experience any abnormal symptoms, such as fever, difficulty breathing, feeling tired easily, chest pain, leg pain, or any other symptoms out of the ordinary, please see your doctor immediately.
The severity of complications after the procedure depends on your health before the procedure. Possible complications include:
  • Bleeding where the catheter is inserted (3.4%)
  • Infection at the insertion site (0%)
  • Permanent atrial fibrillation (0.3%)
  • Kidney failure (1.7%)
  • Complications in the digestive tract that requires surgery (0.3%)
  • Myocardial infarction (1.1%)
  • Emergency valve repair surgery (0%)
  • Major stroke (3.4%)
  • Death from the procedure (less than 1%)
 
Please See Your Doctor
       Please let your doctor know immediately if you experience any of the following:
  • Worsening bleeding, pain, and swelling at the insertion site at the groin, bruising that spreads to a  wide area, the leg or toes on the side where the catheter was inserted is/are cold or changes color
  • Chest pain
  • Difficulty breathing, wheezing
  • Palpitations, dizziness
  • Feeling faint
  • Numbness in the body, difficulty speaking
  1. You must stay in Thailand for approximately two to three weeks for the duration of the treatment and it is recommended you stay in a hotel close to the hospital for convenience in traveling to the hospital before and after the procedure.
  2. If you will return to your home country by plane and will be sitting in Economy Class, it is recommended you sit in the exit row and get up to walk around every 15-30 minutes. Flex and point your feet regularly to prevent deep vein thrombosis.
  3. Take all prescribed medication and carry adequate medication with you when you travel. Have extra medication in your carry-on bag in case your luggage is delayed or lost. Keep your doctor’s prescription with you to avoid any problems when going through airports/customs.
The success of the procedure depends on many factors. Please talk to your doctor if you have any questions or concerns.
 
What if the procedure isn’t performed?
The mitral valve is a valve with two flaps in the heart that lies between the left atrium and the left ventricle. It is also known as the bicuspid valve and has two cusps or flaps. The mitral valve regulates the flow of blood from your lungs into the left ventricle, the main pumping chamber, and closes to keep blood from leaking backward. When the flaps are torn or stretched out or the cusps don’t meet appropriately due to problems with the heart, a leaky valve can occur. A serious leaky mitral valve can lead to mitral valve regurgitation, causing too much blood to flow to the left atrium. Blood can collect in the heart and lungs, increasing pressure in the lungs and causing pulmonary edema, which can then lead to heart failure.

Patients normally cough up blood, are easily fatigued, have difficulty breathing, wheeze, have trouble lying flat, experience swelling of the legs, have excessive fluid in the abdomen, feel weak, and struggle going up even one flight of stairs. If the mitral valve is leaky, heart failure cannot be treated with standard medication. This leads to higher hospital admissions, decreased quality of life, and even death.
 
Your doctor may recommend treatment with medication or open heart surgery to repair or replace the valve.

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