Our Summary

This research paper discusses a procedure for treating heart valve disease known as Transcatheter Mitral Valve Replacement (TMVR). Traditionally, this procedure has been performed through a method known as the transapical approach. However, more recently, a new method known as the transseptal approach is becoming more common as it is less invasive and safer. The transseptal approach, though, is more technically difficult and there is less known about what preparation is needed before this procedure. The authors of this paper provide a detailed guide for doctors on how to carry out the transseptal TMVR procedure, from the pre-procedure checks to the follow-up care.

FAQs

  1. What is transcatheter mitral valve replacement (TMVR)?
  2. What is the difference between transapical and transseptal TMVR procedures?
  3. What screening process is required before undergoing a transseptal TMVR procedure?

Doctor’s Tip

A helpful tip a doctor might tell a patient about mitral valve replacement is to follow a healthy lifestyle with regular exercise and a balanced diet to help improve overall heart health and reduce the risk of complications after the procedure. It is also important to attend all follow-up appointments and adhere to any medication regimen prescribed by the doctor to ensure the success of the mitral valve replacement.

Suitable For

Patients who are typically recommended for mitral valve replacement include those with severe mitral valve disease such as mitral regurgitation or mitral stenosis, who have symptoms such as shortness of breath, fatigue, and chest pain. Candidates for mitral valve replacement may also have failed previous mitral valve repair procedures or have contraindications to traditional open-heart surgery. Additionally, patients with specific anatomical characteristics, such as mitral annular calcification or complex mitral valve pathology, may be considered for transcatheter mitral valve replacement as an alternative therapy. Ultimately, the decision to recommend mitral valve replacement will depend on a thorough evaluation of the patient’s medical history, symptoms, and overall health status.

Timeline

Before mitral valve replacement:

  1. Patient presents with symptoms such as shortness of breath, chest pain, fatigue, and palpitations.
  2. Patient undergoes diagnostic tests such as echocardiogram, cardiac catheterization, and stress tests to determine the severity of mitral valve disease.
  3. Patient is evaluated by a cardiologist and cardiothoracic surgeon to determine if they are a candidate for mitral valve replacement.
  4. Patient undergoes pre-operative preparations such as blood tests, imaging studies, and consultations with anesthesia and other specialists.

After mitral valve replacement:

  1. Patient undergoes mitral valve replacement surgery, either through traditional open-heart surgery or minimally invasive techniques such as transcatheter approaches.
  2. Patient is monitored in the intensive care unit post-operatively for complications such as bleeding, infection, and arrhythmias.
  3. Patient is transferred to a regular hospital room for further monitoring and recovery.
  4. Patient undergoes cardiac rehabilitation and physical therapy to regain strength and mobility.
  5. Patient is discharged from the hospital with instructions for medication management, follow-up appointments, and lifestyle modifications.
  6. Patient undergoes regular follow-up appointments with their cardiologist to monitor their heart function and valve function post-surgery.

What to Ask Your Doctor

  1. What are the benefits of mitral valve replacement compared to other treatment options for my mitral valve disease?

  2. What are the potential risks and complications associated with mitral valve replacement surgery?

  3. How will the procedure be performed (transapical vs transseptal approach) and why is one approach recommended over the other for my specific case?

  4. What is the expected recovery time following mitral valve replacement surgery?

  5. How long will the replacement valve last and will I need any additional procedures in the future?

  6. What lifestyle changes or restrictions will I need to follow after surgery?

  7. What is the success rate of mitral valve replacement surgery in patients with similar characteristics to mine?

  8. What follow-up appointments and monitoring will be necessary after the procedure?

  9. Are there any alternative treatments or therapies that should be considered in conjunction with mitral valve replacement?

  10. What are the long-term implications of having a mitral valve replacement, and how will it affect my overall heart health?

Reference

Authors: Urena M, Himbert D, Brochet E, Carrasco JL, Iung B, Nataf P, Vahanian A. Journal: JACC Cardiovasc Interv. 2017 Oct 9;10(19):1905-1919. doi: 10.1016/j.jcin.2017.06.069. PMID: 28982555