Transcatheter Mitral Valve Replacement: What to Expect at Home

A transcatheter mitral valve replacement (TMVR) is a procedure to replace 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 has replaced the valve. A small cut (incision) was made in your groin. Then a thin, flexible tube (catheter) with tools and a new valve inside it was put inside your blood vessel and carefully guided to your heart. The new mitral valve was placed in position, and the catheter was removed.

After the procedure, you’ll spend up to a few days in the hospital. Your groin may have a bruise and feel sore for a few days. This is where the catheter was inserted into your blood vessel.

Most people can return to regular activities in about a month. Your doctor may give you specific instructions on when you can do your normal activities again.

Your doctor may suggest that you attend a cardiac rehab program. In cardiac rehab, a team of health professionals provides education and support to help you recover and prevent problems with your heart. Ask your doctor if rehab is right for you.

• Allow your body to heal. Do not do strenuous exercise or lift, pull, or push anything heavy until your doctor says it's okay. This may be for at least a month.
• Rest when you feel tired.
• Don’t smoke, vape, or use other tobacco or nicotine products. These things slow healing and recovery. If you need help quitting, talk to your doctor about quit programs and medicines. These can increase your chances of quitting for good.
• Ask your doctor when you can drive again.

• Eat heart-healthy foods. These foods include vegetables, fruits, nuts, beans, lean meat, fish, and whole grains. Limit sodium, alcohol, and sugar.
• If your bowel movements are not regular right after the procedure, try to avoid constipation and straining. Drink plenty of water. Your doctor may suggest fiber, a stool softener, or a mild laxative.

• Your doctor will tell you if and when you can restart your medicines. The doctor will also give you instructions about taking any new medicines.
• If you stopped taking aspirin or some other blood thinner, your doctor will tell you when to start taking it again.
• Your doctor will prescribe a blood-thinning medicine after your procedure. It is very important to take this medicine exactly as directed to prevent blood clots on your new valve.
• Be safe with medicines. Take your medicines exactly as prescribed. Contact your doctor if you think you are having a problem with your medicine.

• Wash your hands before and after touching your incision.
• For 1 or 2 days, keep a bandage over the incision where the catheter was inserted. The bandage probably will fall off in this time.
• Put ice or a cold pack on the area for 10 to 20 minutes at a time to help with soreness or swelling. Put a thin cloth between the ice and your skin.
• You may shower 24 to 48 hours after the procedure, if your doctor okays it. Pat the incision dry.
• Do not soak the catheter site until it is healed. Don't take a bath until your doctor tells you it is okay.
• Watch for bleeding from the site. A small amount of blood (up to the size of a quarter) on the bandage can be normal.
• If you are bleeding from the site, lie down and press on the area to try to make it stop.

• Carry your device identification card with you at all times.
• Practice good dental hygiene and have regular checkups. Good dental health is especially important. That's because bacteria can spread from teeth and gums to the heart valves.
• Be sure to tell all of your doctors and your dentist that you have a device in your valve. This is important because you may need to take antibiotics before certain procedures to prevent infection.

Call 911 anytime you think you may need emergency care. For example, call if:

• You passed out (lost consciousness).
• You have symptoms of a heart attack. These may include:
  • Chest pain or pressure, or a strange feeling in the chest.
  • Sweating.
  • Shortness of breath.
  • Nausea or vomiting.
  • Pain, pressure, or a strange feeling in the back, neck, jaw, or upper belly or in one or both shoulders or arms.
  • A fast or irregular heartbeat.
• You have symptoms of a stroke. These may include:
  • Sudden numbness, tingling, weakness, or loss of movement in your face, arm, or leg, especially on only one side of your body.
  • Sudden vision changes.
  • Sudden trouble speaking.
  • Sudden confusion or trouble understanding simple statements.
  • Sudden problems with walking or balance.
  • A sudden, severe headache that is different from past headaches.
• You have a fast-growing, painful lump at the catheter site in your groin.
• You are bleeding from the area where the catheter was put in your blood vessel, and the bleeding does not stop with firm pressure.

Contact your doctor now or seek immediate medical care if:

• You have severe belly pain.
• You are bleeding from the area where the catheter was put in your blood vessel, but the bleeding stops with firm pressure.
• You have symptoms of infection, such as:
  • Increased pain, swelling, warmth, or redness.
  • Red streaks leading from the catheter site.
  • Pus draining from the catheter site.
  • A fever.
• Your leg is painful, cold, tingly, or numb or looks pale, bluish, or purplish.
• You have swelling in your legs or ankles or sudden weight gain, such as more than 2 or 3 pounds in a day.

Watch closely for changes in your health, and be sure to contact your doctor if you have any problems.