33418 Transcatheter mitral valve repair, percutaneous approach, including transseptal puncture when performed; initial prosthesis

Name of the Procedure:

Transcatheter Mitral Valve Repair, Percutaneous Approach, Including Transseptal Puncture when Performed; Initial Prosthesis

• Common names: TMVR, Percutaneous Mitral Valve Repair

Summary

Transcatheter mitral valve repair (TMVR) is a minimally invasive heart procedure that aims to repair a damaged mitral valve using a catheter. It is performed by threading a thin tube through the blood vessels to the heart, and in some cases, puncturing the septum (the wall between the left and right atria) to gain access to the mitral valve.

Purpose

• Medical condition: Mitral valve regurgitation (leaking of the mitral valve), mitral stenosis (narrowing of the mitral valve).
• Goals: Restore proper function of the mitral valve to improve blood flow through the heart, alleviate symptoms of heart failure, and enhance the patient's quality of life.

Indications

• Symptoms: Shortness of breath, fatigue, swollen legs, heart palpitations.
• Conditions: Severe mitral valve regurgitation or stenosis not amenable to surgical repair, high-risk surgical patients.

Preparation

• Pre-procedure fasting (usually 6-8 hours before the procedure).
• Adjustments to medications, especially blood thinners.
• Diagnostic tests: Echocardiogram, CT scan, and blood tests to assess heart function and overall health.
• Discussion with the healthcare team about the procedure, risks, and benefits.

Procedure Description

1. The patient is given anesthesia, typically general anesthesia.
2. A catheter is inserted into a large vein, often the femoral vein in the groin.
3. The catheter is carefully guided through the blood vessels to the heart using X-ray imaging.
4. If needed, a transseptal puncture is made to access the left atrium from the right atrium.
5. Specialized tools on the catheter are used to place the mitral valve repair device or prosthesis.
6. Once the repair is complete, the catheter is removed, and the insertion site is closed.

Duration

The procedure typically takes 2-4 hours, depending on complexity.

Setting

Usually performed in a hospital's catheterization lab (cath lab) or cardiac surgery suite.

Personnel

• Interventional cardiologist or cardiac surgeon
• Anesthesiologist
• Nursing staff
• Radiologic technologists

Risks and Complications

• Common risks: Bleeding, infection at the catheter insertion site, reaction to anesthesia.
• Rare risks: Stroke, heart attack, valve malfunction, unintended damage to heart structures.
• Complications management: Immediate medical intervention if complications arise.

Benefits

• Expected benefits: Improved heart function, relief from symptoms like shortness of breath and fatigue, improved quality of life.
• Timeline: Benefits are often noticed within weeks of the procedure.

Recovery

• Post-procedure care: Hospital stay for 1-2 days for monitoring, bed rest initially, gradually returning to normal activities.
• Follow-up: Regular visits to the cardiologist, echocardiograms to assess valve function.
• Restrictions: Avoid strenuous activities for several weeks.

Alternatives

• Traditional open-heart surgery for mitral valve repair or replacement.
• Medications to manage symptoms (diuretics, beta-blockers).
• Pros and cons: Surgery may offer a more durable repair but comes with higher risks and longer recovery time. Medications do not address the structural problem.

Patient Experience

• During procedure: Under general anesthesia, so the patient will not be awake or feel pain.
• After procedure: Mild discomfort or bruising at the catheter site, potential soreness in the chest.
• Pain management: Medications provided as needed to manage pain and discomfort.