Our Summary

Mitral regurgitation is a fairly common heart valve disorder. Sometimes, surgery isn’t possible to treat this condition, especially in older or frail patients with other health problems and heart dysfunction. In these cases, a less invasive treatment, called percutaneous treatment, can be used. This involves repairing or replacing the mitral valve through a small incision in the skin.

The Mitraclip device, used for repairing the mitral valve, has shown to improve patient safety and reduce death rates in patients with severe mitral regurgitation. Over the past decade, percutaneous mitral replacement (replacing the valve through a small incision) has provided new possibilities in heart surgery.

However, there are not many devices available for this, and some are still in early development stages or awaiting approval for use in Europe (CE mark). The progress in developing these devices has been slow compared to those for aortic valve surgery, mainly due to the complex nature of the mitral valve and difficulties in accessing it. This paper reviews the current devices available, their specific features, and potential complications.

FAQs

  1. What is mitral regurgitation and how common is it worldwide?
  2. What is the role of percutaneous treatment in managing mitral regurgitation in high-risk patients?
  3. What are some potential complications associated with the use of current devices for mitral valve replacement or repair?

Doctor’s Tip

One helpful tip a doctor might tell a patient about valve replacement is to follow their post-operative care instructions carefully, including taking prescribed medications, attending follow-up appointments, and participating in cardiac rehabilitation programs. It is important for patients to communicate any symptoms or concerns to their healthcare provider promptly to ensure optimal recovery and long-term success of the valve replacement procedure.

Suitable For

Patients who are typically recommended valve replacement are those with severe mitral regurgitation who are at high risk for surgery, such as the elderly and frail with multiple comorbidities and left ventricular dysfunction. Percutaneous treatment, either repair or replacement, may be an option for these patients. Mitral valve repair with devices like the Mitraclip has shown increased safety and mortality reduction in patients with severe mitral regurgitation. Additionally, percutaneous mitral replacement has opened new possibilities for patients who are not candidates for surgery. There are various mitral devices in development, each with specific features and potential complications. This review provides an overview of these devices and their use in treating mitral valve disease.

Timeline

Before valve replacement:

  1. Patient presents with symptoms such as shortness of breath, fatigue, and chest pain
  2. Diagnosis of mitral valve disease is confirmed through imaging tests such as echocardiography
  3. Patient undergoes evaluation to determine if they are a suitable candidate for valve replacement, considering factors such as age, overall health, and severity of the condition

After valve replacement:

  1. Patient undergoes minimally invasive or open-heart surgery to replace the malfunctioning mitral valve
  2. Recovery period in the hospital, where the patient is closely monitored for any complications
  3. Rehabilitation and physical therapy to regain strength and mobility
  4. Follow-up appointments with the healthcare team to monitor the function of the new valve and make any necessary adjustments
  5. Improvement in symptoms such as reduced shortness of breath and increased energy levels
  6. Long-term management of the new valve with regular check-ups and medications to prevent complications.

What to Ask Your Doctor

  1. What are the different options for mitral valve replacement, and which one do you recommend for me?
  2. What are the potential risks and complications associated with mitral valve replacement surgery?
  3. How long is the recovery process after mitral valve replacement surgery, and what can I expect during the recovery period?
  4. Will I need to take any medications after the surgery, and if so, what are they for and how long will I need to take them?
  5. How often will I need to follow up with you after the surgery, and what will those follow-up appointments entail?
  6. Are there any lifestyle changes or restrictions I need to be aware of after mitral valve replacement surgery?
  7. What is the long-term prognosis for someone who has undergone mitral valve replacement surgery?
  8. Are there any alternative treatments or options to consider before proceeding with mitral valve replacement surgery?
  9. What is your experience and success rate with mitral valve replacement surgeries?
  10. Are there any specific pre-operative tests or preparations I need to undergo before the surgery?

Reference

Authors: Gheorghe L, Brouwer J, Wang DD, Wunderlich N, Rana B, Rensing B, Eefting F, Timmers L, Swaans M. Journal: Front Cardiovasc Med. 2020 Nov 27;7:531843. doi: 10.3389/fcvm.2020.531843. eCollection 2020. PMID: 33330637