Transcatheter Mitral Valve Replacement: Before Your Procedure

A transcatheter mitral valve replacement (TMVR) is a procedure to treat a mitral valve that is not working well. The mitral valve is made of flaps that work together to open and close. The valve's job is to make sure the blood flows in only one direction. Sometimes the valve does not work the way it should. There are two main problems that can happen. They are:

• Regurgitation. The flaps don't close correctly. Blood leaks back into a chamber of the heart instead of moving forward.
• Stenosis. The flaps become stiff or thick and don't open all the way. This makes it harder for blood to flow through the valve.

Both problems make the heart work harder to pump blood.

Your heart doctor can treat your condition by replacing the mitral valve with a specially designed replacement valve. The doctor will make a small cut (incision) in your groin. A thin, flexible tube (catheter) that has tools and the new valve inside it is put inside your blood vessel and carefully guided to your heart. The new valve is released in position and the catheter is removed.

You'll be asleep for the procedure. You may stay in the hospital for up to a few days.

Procedures can be stressful. This information will help you understand what you can expect. And it will help you safely prepare for your procedure.

• Understand exactly what procedure is planned, along with the risks, benefits, and other options.
• Tell your doctor ALL the medicines, vitamins, supplements, and herbal remedies you take. Some may increase the risk of problems during your procedure. Your doctor will tell you if you should stop taking any of them before the procedure and how soon to do it.
• If you take aspirin or some other blood thinner, ask your doctor if you should stop taking it before your procedure. Make sure that you understand exactly what your doctor wants you to do. These medicines increase the risk of bleeding.
• Don’t smoke, vape, or use other tobacco and nicotine products. These things increase the procedure's risks. Your doctor may require that you quit for a period of time before and after the procedure. You have the best chance for a healthy recovery if you quit completely. If you need help quitting, talk to your doctor about quit programs and medicines.
• Make sure your doctor and the hospital have a copy of your advance directive. If you don’t have one, you may want to prepare one. It lets others know your healthcare wishes. It’s a good thing to have before any type of surgery or procedure.
• Be sure you have someone to take you home. Anesthesia and pain medicine will make it unsafe for you to drive or get home on your own.

• Follow the instructions exactly about when to stop eating and drinking. If you don't, your procedure may be canceled. If your doctor told you to take your medicines on the day of the procedure, take them with only a sip of water.
• Follow your doctor's instructions about when to bathe or shower before your procedure. Do not apply lotions, perfumes, deodorants, or nail polish.
• Do not shave the surgical site yourself.
• Take off all jewelry and piercings. And take out contact lenses, if you wear them.

• Bring a picture ID.
• You will be kept comfortable and safe by your anesthesia provider. The anesthesia will likely make you sleep. You won't feel pain when the catheter is put in the blood vessel.
• The procedure will take about 3 to 4 hours.

• After the procedure, pressure may be applied to the area where the catheter was put into your blood vessel. This will help prevent bleeding. A small device may also be used to close the blood vessel. You may have a bandage or a compression device on the catheter site.
• You will need to lie still and keep your leg straight for up to a few hours. A weighted bag may be put on your leg to help you keep it still.