Transcatheter Valve Procedures

There are various TAVR techniques that are used:

• Transfemoral approach: Through a small incision made in the leg; this is the most common procedure
• Subclavian approach: Through an incision near the shoulder
• Transapical approach: Through an incision in the chest between the ribs
• Transaortic approach: Through an incision in the upper chest

Initially the patient will be enrolled in the Valve Clinic. All pre-operative work up will be coordinated by the Valve Clinic ARNP and RN. Once cleared for surgery, the patient will be admitted to the hospital the day before for medical optimization or will be brought to the hospital the morning of the procedure.

The procedure typically lasts two hours. After the procedure, you will be admitted to our hospital for care. The length of stay for a TAVR procedure is usually two days, after which you will follow up with your cardiologist within 30 days and then in one year. You will be back to your normal life in less than 4 weeks after TAVR.

Aftering making a small incision in the groin, a tube is passed up through the leg vessels to the right side of the heart and the tube then passed into the left side of the heart using a technique known as trans-septal puncture. This is a very specialized technique and gives access to the mitral valve.

The MitraClip is then passed up through this tube and into the left side of the heart, connected to a delivery system. The MitraClip is then positioned over the leaky mitral valve and using the delivery system, small adjustments are made to ensure the clip is in the desired position.

After further positioning the MitraClip pulled back upwards and the mitral leaflets are grasped. The clips are then closed and the valve reassessed to ensure that there is an immediate reduction in the mitral regurgitation. The MitraClip remains firmly attached to the mitral valve leaflets.

Most of the proven benefits of reduction of severity of mitral regurgitation by the MitraClip are quality of life.

• Improved quality of life
• Improvement in symptoms
• Decreased chance of being hospitalized
• Favorable reduction in heart size
• Improvement in heart shape
• Reduction in mitral regurgitation
• Avoidance of prohibitively high surgical risk

Initially the patient will be enrolled in the Valve Clinic. All pre-operative work up will be coordinated by the Valve Clinic ARNP and RN. Once cleared for MitraClip, the patient will be admitted to the hospital the day before for medical optimization or will be brought to the hospital the morning of the procedure.

An interventional cardiologist and a cardiac surgeon team specialized in structural heart disease perform the MitraClip procedure. A heart team approach is required for MitraClip patient selection and consists of an interventional structural cardiologist, a cardiac surgeon, and a cardiologist specializing in imaging and valvular heart disease.

During the procedure images are obtained and interpreted in a 3-Dimensional fashion, allowing an immediate understanding of working in valve and accurate placement of the MitraClip.

The whole process has three steps: the pre-procedure, the procedure, and post-procedure recovery.

• Most patients will have been assessed in valve clinic to assess suitability for the MitraClip procedure.
• Patients arrive on the morning of the procedure. Some basic lab tests are done and the patient will meet the anesthesiologist.
• In the procedure room, the patient will be put to sleep for the procedure and a breathing tube inserted. This will usually be taken out as soon as the procedure is done.
• In experienced centers, the procedure itself can take from 2 to 3 hours. Sometimes it can be longer if required depending on the complexity of the case.
• After the procedure the patient will go to the hospital when felt to be stable enough, the patient will be sent to a step down unit.
• Patients home in two days after the procedure.

As of now, in the US, the MitraClip is only FDA approved. Transcatheter device for the treatment of severe degenerative mitral regurgitation. Your cardiologist and cardiac surgeon will make the decision if you are eligible for MitraClip procedures based on your disease process, comorbidities and age. This is a personalized decision catered to the needs of each patient based on all the variables discussed above.

The procedure is typically two to three hours long. After the procedure you will be admitted to the hospital. The length of stay for a MitraClip procedure is two to three days, after which you will follow up with your cardiologist within 30 days and then in one year. You will be back to your normal life in less than 4 weeks.