33419 Transcatheter mitral valve repair, percutaneous approach, including transseptal puncture when performed; additional prosthesis(es) during same session (List separately in addition to code for primary procedure)

Name of the Procedure:

Transcatheter Mitral Valve Repair (TMVR), Percutaneous Approach, Including Transseptal Puncture When Performed; Additional Prosthesis(es) During Same Session

Summary

Transcatheter Mitral Valve Repair (TMVR) is a minimally invasive procedure used to fix a leaking mitral valve, which is a critical heart valve that ensures blood flows correctly between the heart chambers. The percutaneous approach involves making a small incision through the skin to insert catheters and reach the heart. The process may also include a transseptal puncture, which is a small hole made in the wall separating the heart's chambers. During the same session, additional prosthetic devices can be placed if needed to ensure valve functionality.

Purpose

The procedure aims to treat mitral valve regurgitation, a condition where the mitral valve does not close tightly, causing blood to flow backward in the heart. It helps improve the symptoms of heart failure, reduce heart size, and enhance overall heart function.

Indications

• Symptoms of mitral valve regurgitation like shortness of breath, fatigue, or swelling.
• Severe mitral valve regurgitation confirmed by echocardiography or other imaging techniques.
• Patients who are not ideal candidates for open-heart surgery due to high surgical risk, age, or comorbidities.

Preparation

• Patients may be required to fast for several hours before the procedure.
• Medications may need to be adjusted or temporarily halted based on medical advice.
• Pre-procedural assessments, including blood tests, ECG, chest X-ray, and echocardiography, may be conducted to evaluate heart function and anatomy.

Procedure Description

1. The patient is given sedation or general anesthesia for comfort.
2. A small incision is made, usually in the groin, to access a vein.
3. A catheter is inserted through the vein and guided to the heart using imaging technology for precision.
4. A transseptal puncture is performed if needed, allowing the catheter to cross from the right atrium to the left atrium.
5. The mitral valve is then accessed, and the repair device is positioned and deployed to improve valve function.
6. If required, additional prosthetic devices are placed to ensure optimal valve function.
7. The catheter is withdrawn, and the incision site is closed.

Duration

The procedure typically takes between 2 to 4 hours, though this may vary based on the complexity of the repair.

Setting

TMVR is performed in a hospital setting, specifically in a cardiac catheterization laboratory or an operating room equipped for interventional cardiology procedures.

Personnel

• Interventional Cardiologist or Cardiac Surgeon
• Anesthesiologist
• Cardiac Nurse
• Radiologic Technologist
• Echocardiography Technician

Risks and Complications

• Bleeding or infection at the incision site
• Stroke or transient ischemic attack (TIA)
• Heart rhythm problems
• Injury to blood vessels or heart structures
• Device malfunction or displacement
• Rarely, death

Benefits

• Improved heart function and reduced symptoms of mitral regurgitation
• Minimally invasive, which typically means shorter recovery time and less discomfort compared to open-heart surgery
• Improved quality of life and increased physical activity tolerance

Recovery

• Patients often stay in the hospital for 1-2 days for monitoring.
• Post-procedure instructions include taking prescribed medications, avoiding strenuous activities for a certain period, and attending follow-up appointments.
• Most patients can resume normal activities within a week, but full recovery may take several weeks.

Alternatives

• Open-heart mitral valve surgery
• Medical management with medications that manage symptoms but do not correct the underlying issue
• Lifestyle changes to manage heart disease symptoms
• Each option has its pros and cons, with TMVR providing a less invasive alternative to surgery but not suitable for all patients.

Patient Experience

During the procedure, patients under sedation or anesthesia will not feel pain. After the procedure, patients might experience mild discomfort at the incision site and some soreness, which can be managed with pain medications. Patients can expect to feel improved in terms of symptoms like breathlessness within days to weeks following the procedure.