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Transcatheter Tricuspid and Mitral Valve Replacement

Transcatheter tricuspid and mitral valve replacement is a treatment for patients with moderate to severe regurgitation. Regurgitation is the name for leaking heart valves.

A leaking mitral valve allows blood to flow in two directions during the contraction of the heart. Some blood flows from the ventricle through the aortic valve. This is normal. It's when some blood flows back into the atrium through the defective mitral valve each time the left ventricle contracts that you have a problem.

A leaking tricuspid valve is when the right ventricle contracts to pump blood forward to the lungs, and some blood leaks backward into the right atrium. This increases the volume of blood in the atrium. As a result, the right atrium can enlarge. This changes the pressure in the nearby heart chambers and blood vessels.

A replacement valve is a self-expanding stent with an integrated tissue valve. The tissue is expanded directly into the mitral or tricuspid valve to stop the backflow of blood. The inner stent houses the valve for maintaining blood flow. The outer stent secures the implant within the diseased valve. This reduces the need for additional sutures or tethers. The new valve can be inserted from the femoral vein with a catheter. This is a less invasive, and less dangerous, procedure than open heart surgery.

Why choose Presbyterian for your transcatheter tricuspid and mitral valve replacements?

Presbyterian Heart and Vascular Care has a team of highly-skilled surgeons who are using some of the most advanced techniques to perform this procedure. These techniques can improve recovery time, reduce complications and provide a quicker return to work and other daily activities.

Who is eligible for a transcatheter tricuspid and mitral valve replacements?

Patients who have valve stenosis, an enlarged atrium, pulmonary hypertension, or who are at risk for traditional open-heart surgery may be eligible for this replacement procedure. To determine whether valve replacement is appropriate, patients will be evaluated with tests that include:

  • Cardiac catheterization: This test lets your doctor diagnose and treat various heart and vascular conditions with thin, flexible tubes called catheters that are threaded through blood vessels to problem areas.

  • Chest X-ray: Chest X-rays create pictures of the structures inside the chest, including the lungs, heart, and chest wall.

  • Echocardiogram: An echocardiogram uses high-frequency sound waves to create images of your heart.

  • Electrocardiogram (EKG): An EKG measures the heart’s electrical activity.

  • Magnetic resonance imaging (MRI): A cardiac MRI is a combination of radio waves, magnets, and computer technology that create images of your heart and blood vessels.

  • Transesophageal echocardiogram (TEE): TEE takes very detailed images of your heart structure from a probe in your esophagus.

What conditions can be treated with a transcatheter tricuspid and mitral replacements?

Mitral and tricuspid valve replacement treats regurgitation, a common valvular heart disease, or mitral stenosis. People with regurgitation may experience:

  • Fatigue.

  • Dizziness.

  • Chest pain.

  • Passing out.

  • Shortness of breath.

  • Swelling in your legs.

  • Unpleasant awareness of your heartbeat.

The underlying cause of regurgitation is often pulmonary hypertension, either from left-sided heart failure, mitral or aortic valve disease, or primary pulmonary causes. Atrial fibrillation may be both a sign of the disease getting worse.

How do I prepare for a transcatheter tricuspid and mitral valve replacements?

As you prepare for the surgery, you and your healthcare provider will decide what kind of valve will work best for you. Your surgeon will replace your valve with a biological valve or a mechanical valve.

  • Biological valves are made mainly from pig, cow, or human heart tissue. They don’t last as long as mechanical valves but have less risk for blood clots.

  • Mechanical valves are human-made. People with mechanical valves need to take blood-thinning medicines for the rest of their lives because of the risk for blood clots. Mechanical valves also have an increased risk for infection.

Remember the following:

  • Avoid eating or drinking anything after midnight before your surgery.

  • Try to stop smoking before your operation. Ask your doctor for ways to help.

  • You may need to stop taking certain medicines before your surgery. Follow your healthcare provider’s instructions if you usually take blood-thinning medications like warfarin or aspirin.

About an hour before the operation, someone will give you medicines to help you relax. In most cases, your surgery will proceed as planned, but sometimes another emergency might delay your operation.

What should I expect during my transcatheter tricuspid and mitral replacements?

The procedure is performed using one of several approaches. The two most common approaches are:

  • Transfemoral: enters through the femoral artery.

  • Transapical: uses a minimally invasive surgical approach with a small incision in the chest.

During the procedure:

  • An IV will be inserted into your arm to provide sedation, medication, and fluids.

  • A thin, flexible tube known as a catheter will be inserted into an artery in your groin or arm. Using X-ray images, your surgeon will guide the catheter to the diseased valve.

  • The valve will be carried by the catheter and placed using a balloon that presses the valve into place. The catheter is then removed, and you are taken to the recovery area.

After the procedure:

  • You will start your recovery in the intensive care unit or a recovery room.

  • The team will monitor your vital signs.

  • You may have a tube in your throat to help you breathe. Someone will usually remove the tube within 24 hours.

  • You may have a chest tube to drain excess fluid from your chest.

  • You may have small temporary pacemaker wires exiting from your chest.

  • You will feel some soreness, but you shouldn’t feel severe pain. You can ask for pain medicine.

  • In a day or two, you should be able to sit in a chair and walk with help.

  • You will probably need to stay in the hospital for around five days.

How do I care for myself after my transcatheter tricuspid and mitral replacements?

You will probably have your stitches or staples removed in a follow-up appointment in seven to ten days. Be sure to keep all follow-up appointments. It may be several weeks before you fully recover.

At home, take your temperature and your weight every day. Tell your doctor if your temperature is over 100.4°F (38°C), or if your weight changes. Ask when it is safe for you to drive. Avoid lifting anything heavy for several weeks. Ask your healthcare provider about what is safe for you to lift. Follow all the instructions your healthcare provider gives you for medicines, exercise, diet, and wound care.

Make sure all your dentists and other healthcare providers know about your medical history. You may need to take antibiotics before certain medical and dental procedures to prevent getting an infection on your replacement valve.

Patients who receive a mechanical valve will require a blood-thinning medication for the rest of their lives. The blood thinner will keep clots from forming.