Transcatheter Mitral Repair
What is the mitral valve?
Your heart is a strong muscle that pumps blood around your body. Blood flows through the heart in a one-way direction, guided by valves that open and close with each heartbeat.
The mitral valve sits between the left atrium (upper chamber) and the left ventricle (lower chamber). Its role is to allow blood to flow forward into the left ventricle and to prevent blood from leaking backwards when the heart pumps.
Over time, the mitral valve can develop problems, most commonly:
- Mitral regurgitation – the valve becomes leaky, allowing blood to flow backwards into the left atrium.
Mitral regurgitation may be:
- Degenerative (primary) – due to wear and tear of the valve itself, or • Functional (secondary) – due to enlargement or weakening of the heart muscle.
Mitral regurgitation can cause symptoms such as shortness of breath, fatigue, reduced exercise tolerance, leg swelling, palpitations, and progressive heart failure.
How is the mitral valve treated?
Treatment depends on the cause and severity of the leak, your symptoms, and your overall health. Options include medications, surgery, or a catheter-based procedure
- Surgical Mitral Valve Repair or Replacement
This involves open-heart surgery under a general anaesthetic. The chest is opened through the breastbone (sternotomy), and the mitral valve is either repaired or replaced.
While surgery can be very effective, it may carry higher risk in some patients due to age, frailty, or other medical conditions.
- Mitral Transcatheter Edge-to-Edge Repair (TEER)
Mitral TEER is a minimally invasive procedure used to treat significant mitral regurgitation in selected patients who are at higher risk for open-heart surgery.
Rather than replacing the valve, the procedure uses a small device to clip or approximate the valve leaflets together, reducing the amount of leak while allowing blood to continue to flow forward.
What happens when I come in for the procedure?
Before your mitral TEER procedure, you will already have completed a detailed assessment, which may include:
- An ultrasound of your heart (echocardiogram, including transoesophageal echo)
- Blood tests
- In some cases, a coronary angiogram or a CT scan
Based on these results and discussion between Dr Blusztein and the multidisciplinary heart team at Cabrini, it has been determined that mitral TEER is the most suitable treatment option for you.
Admission and preparation
- You will be admitted to hospital on the afternoon before the procedure.
- Nurses will perform blood tests and an ECG.
- You will be given special skin cleansing products to reduce the risk of infection.
- An anaesthetist will meet you to discuss the anaesthetic plan. This procedure is usually performed under general anaesthetic to allow continuous ultrasound guidance.
- Dr Blusztein will also meet with you to answer any questions.
On the day of the procedure
- You will be taken to the cardiac catheterisation laboratory.
- After you are asleep, a specialised ultrasound probe (transoesophageal echocardiogram) is placed down the oesophagus to guide the procedure.
- The skin in the groin will be cleaned with antiseptic and covered with sterile drapes.
Dr Blusztein will then insert a catheter into the femoral vein in the groin and guide it up to the heart. A small puncture is made between the upper chambers of the heart to access the mitral valve.
Using ultrasound and X-ray guidance, one or more clips/devices are positioned to bring the mitral valve leaflets together, reducing the leak.
The procedure usually takes 2–3 hours.
Once finished:
- The catheters are removed
- Internal stitches are used to close the vein
- You will be transferred to a recovery area and then back to the ward
Are there risks?
Mitral TEER is a major heart procedure, even though it is minimally invasive. All heart procedures carry some level of risk.
Potential risks include (but are not limited to):
- Bleeding or vascular complications at the groin
- Stroke
- Heart rhythm disturbances
- Infection
- Kidney impairment
- Damage to the mitral valve or surrounding heart structures
- Residual or recurrent mitral regurgitation
- Rarely, the need for emergency heart surgery or death
We would only recommend this procedure if the benefits outweigh the risks. The specific risks vary between patients, and Dr Blusztein will discuss these with you in detail.
What happens after the procedure?
The typical hospital stay is overnight.
- You will have an ultrasound of your heart the following day to assess the result of the procedure.
- Your heart rhythm and groin access site will be closely monitored.
- Most patients notice an improvement in symptoms over the following weeks.
Please note that current government regulations require you not to drive for four weeks after the procedure.
A follow-up appointment will be arranged, usually 30 days after the procedure, along with another echocardiogram. A letter will be sent to your GP and any other specialists involved in your care.
If you have questions at any time, please contact us.
Should I stop any medications?
This will be discussed when your procedure is booked. Please provide a current list of all medications you are taking.
If you are taking aspirin, you may continue it unless advised otherwise.
Please notify us if you take any of the following: Important medications to tell us about
- Warfarin
- Apixaban
- Dabigatran
- Rivaroxaban
- Metformin
- Empagliflozin
- Dapagliflozin
- Insulin
Do I need to fast?
On the evening before the procedure, you may eat and drink as normal. You must then fast from midnight.
On the morning of the procedure, you may take your usual medications (unless advised otherwise) with a small sip of water.
Who should I contact if I have questions?
If you have any questions or concerns, please contact us:
- Phone: (03) 9500 0296
- In person: Suite 17, Cabrini Hospital, Malvern
- Website: www.melbourneheart.com.au/contact/
If your symptoms worsen while waiting for your procedure, please let us and your referring doctor know.
