Transcatheter mitral valve implantation/replacement (TMVI) with prosthetic valve; percutaneous approach, including transseptal puncture, when performed
CPT4 code
Name of the Procedure:
Transcatheter Mitral Valve Implantation/Replacement (TMVI) with Prosthetic Valve; Percutaneous Approach, Including Transseptal Puncture
Summary
Transcatheter Mitral Valve Implantation (TMVI) is a minimally invasive procedure used to replace a diseased mitral valve with a prosthetic valve. This procedure is performed using a catheter-based approach and involves accessing the mitral valve through the blood vessels rather than through open-heart surgery.
Purpose
TMVI addresses mitral valve diseases such as mitral regurgitation or mitral stenosis, where the valve either leaks blood backward into the heart or is too narrow, respectively. The goal is to improve heart function, alleviate symptoms, and enhance the quality of life for patients who are not candidates for traditional open-heart surgery.
Indications
- Severe mitral regurgitation or mitral stenosis
- Symptoms such as shortness of breath, fatigue, or swelling in the legs
- High surgical risk due to other medical conditions
- Poor response to previous medical or surgical treatments
Preparation
- Patients may need to fast for 8-12 hours before the procedure.
- Discontinuation or adjustment of certain medications, as advised by the physician.
- Pre-procedure diagnostic tests such as echocardiography, CT scans, or cardiac MRI.
- Blood tests to assess overall health and readiness for surgery.
Procedure Description
- Preparation and Anesthesia: The patient is given local or general anesthesia, depending on their condition.
- Catheter Insertion: A catheter is inserted through a blood vessel in the groin and advanced towards the heart.
- Transseptal Puncture: A small puncture is made in the septum (the wall between the left and right atria) to access the left side of the heart.
- Valve Placement: The diseased mitral valve is replaced with a prosthetic valve delivered via the catheter.
- Balloon Expansion: In some cases, a balloon may be used to expand the prosthetic valve to ensure proper placement and function.
- Catheter Removal and Closure: The catheter is removed, and the entry site is closed.
Duration
The procedure typically takes between 2 to 4 hours.
Setting
TMVI is usually performed in a hospital's catheterization laboratory or a specialized surgical center.
Personnel
- Interventional cardiologists
- Cardiac surgeons
- Anesthesiologists
- Specialized nurses and technicians
Risks and Complications
- Bleeding at the catheter insertion site
- Risk of stroke or heart attack
- Infection
- Arrhythmias (irregular heartbeats)
- Prosthetic valve malfunction
- Rare complications such as injury to the heart or blood vessels
Benefits
- Relief from symptoms such as shortness of breath, fatigue, and swelling
- Improved heart function
- Reduced recovery time compared to open-heart surgery
- Enhanced quality of life
Recovery
- Monitoring in the hospital for a few days post-procedure
- Gradual return to normal activities within a few weeks
- Follow-up appointments for echocardiography and other assessments
- Adherence to prescribed medications and lifestyle adjustments
Alternatives
- Medical management with medications
- Traditional mitral valve surgery (open-heart surgery)
- Minimally invasive mitral valve repair
- Mitral clip procedure for repair of the valve
Pros of alternatives: Potential for longer-lasting results with surgical repair, various options suitable for different patient profiles.
Cons of alternatives: Higher risk, longer recovery time, and not suitable for high-risk patients.
Patient Experience
- During the procedure: Patients under local anesthesia may feel some pressure at the catheter insertion site; those under general anesthesia will be asleep and feel nothing.
- After the procedure: Some soreness or bruising at the catheter site; temporary fatigue.
- Pain management: Pain relief medications, as needed, and specific instructions for home care.