By: Abdi Waluyo Hospital

Overview

What is Transcatheter Mitral Valve Repair (TMVr)?

Transcatheter Mitral Valve Repair (TMVr) is a minimally invasive procedure used to treat mitral regurgitation (MR), a condition in which the mitral valve does not close properly, allowing blood to leak backward from the left ventricle into the left atrium.

Unlike conventional open-heart surgery, TMVr repairs the mitral valve through a catheter inserted into a vein, usually in the groin, without the need to open the chest or temporarily stop the heart. Using advanced imaging guidance, a specialized repair device is delivered to the mitral valve to improve leaflet coaptation (closure), significantly reducing valve leakage while preserving the patient’s native valve.

TMVr is an important treatment option for patients with severe mitral regurgitation who are considered at high or prohibitive risk for conventional heart surgery due to age, frailty, or other medical conditions.

At RS Abdi Waluyo, Transcatheter Mitral Valve Repair is performed by a multidisciplinary Structural Heart Team comprising interventional cardiologists, cardiac surgeons, cardiac imaging specialists, cardiac anesthesiologists, and specialized nurses. Procedures are carried out in a state-of-the-art Hybrid Catheterization Laboratory (Hybrid Cath Lab) equipped with advanced imaging technology to maximize precision, safety, and clinical outcomes.

Why is Transcatheter Mitral Valve Repair Performed?

Your cardiologist may recommend TMVr if you have:

Severe mitral regurgitation causing symptoms.
Degenerative (primary) mitral regurgitation.
Functional (secondary) mitral regurgitation related to heart failure.
Shortness of breath during daily activities.
Fatigue and reduced exercise tolerance.
Recurrent hospitalization for heart failure.
High or prohibitive surgical risk for open-heart valve surgery.
Persistent symptoms despite optimal medical therapy.

The procedure aims to reduce mitral valve leakage, improve heart function, relieve symptoms, and enhance quality of life.

Details of the Procedure

Before undergoing TMVr, you will undergo a comprehensive evaluation, including:

Consultation with an interventional cardiologist and cardiac surgeon.
Physical examination and medical history review.
Blood tests.
Electrocardiogram (ECG).
Transthoracic Echocardiography (TTE).
Transesophageal Echocardiography (TEE) to assess mitral valve anatomy.
Cardiac CT scan when appropriate.
Coronary angiography if indicated.

Before the procedure, you may be instructed to:

Fast for several hours.
Temporarily stop certain medications according to your physician’s instructions.
Inform your doctor of any allergies, kidney disease, bleeding disorders, or implanted medical devices.

The procedure generally takes 2 to 4 hours, depending on the complexity of the valve anatomy.

What Happens During the Procedure?

During TMVr:

The procedure is usually performed under general anesthesia.
A catheter is inserted through the femoral vein in the groin.
Using advanced fluoroscopic imaging and real-time Transesophageal Echocardiography (TEE), the catheter is guided into the heart.
The catheter crosses the interatrial septum to access the left atrium.
A specialized mitral valve repair device is positioned across the leaking valve.
The device grasps the mitral valve leaflets, improving valve closure and reducing regurgitation.
The degree of residual leakage is carefully assessed using TEE before the device is released.
Once satisfactory results are achieved, the delivery system is removed and the access site is closed.

Throughout the procedure, your heart rhythm, blood pressure, oxygen level, and overall condition are continuously monitored.

The Role of the Hybrid Cath Lab

At RS Abdi Waluyo, TMVr is performed in an advanced Hybrid Catheterization Laboratory (Hybrid Cath Lab) specifically designed for complex structural heart procedures.

The Hybrid Cath Lab offers several important advantages:

High-resolution fluoroscopic imaging combined with real-time 3D Transesophageal Echocardiography (3D TEE) for precise device positioning.
Simultaneous visualization of cardiac anatomy and catheter movement throughout the procedure.
Immediate collaboration between interventional cardiologists and cardiac surgeons for complex cases.
The ability to convert to surgical intervention immediately if necessary without transferring the patient.
Enhanced patient safety through integrated imaging, anesthesia, and surgical capabilities.
A comprehensive Heart Team approach, ensuring individualized treatment planning for every patient.

What Should I Expect After the Procedure?

After TMVr:

You will be monitored in the intensive care unit or cardiac recovery unit.
Most patients remain in the hospital for 1 to 3 days.
Walking is usually encouraged within 24 hours after the procedure.
Most patients experience significant improvement in symptoms over the following weeks.
Your doctor will prescribe medications and provide instructions regarding activity, wound care, and follow-up appointments.

Regular echocardiographic follow-up is important to monitor mitral valve function.

What Are the Risks?

TMVr is considered a safe and effective treatment for appropriately selected patients.

Potential risks include:

Bleeding or bruising at the catheter insertion site.
Damage to blood vessels.
Heart rhythm disturbances.
Residual mitral valve leakage.
Device malposition or embolization (rare).
Injury to the mitral valve requiring surgery.
Cardiac perforation (rare).
Kidney injury related to contrast dye.
Death (rare).

Your healthcare team carefully monitors you throughout the procedure to minimize these risks.

Results and Follow-Up

Following TMVr, your cardiologist will evaluate:

Reduction in mitral regurgitation.
Improvement in heart function.
Relief of symptoms.
Left ventricular function.
Pulmonary artery pressure.
Overall quality of life.

Follow-up care typically includes:

Regular cardiology consultations.
Medication optimization.
Heart failure management when appropriate.
Lifestyle modification and cardiac rehabilitation.

When Will I Know the Results?

Your cardiologist can usually discuss the immediate procedural results shortly after the procedure.

Before discharge, you will receive information regarding:

The success of the mitral valve repair.
The degree of residual mitral regurgitation.
Heart function.
Recovery recommendations.
Long-term follow-up plans.

If the Results Are Abnormal, What Are the Next Steps?

If significant mitral regurgitation persists or additional structural heart disease is identified, your Heart Team may recommend:

Adjustment of heart failure medications.
Repeat echocardiographic evaluation.
Additional transcatheter intervention.
Surgical mitral valve repair or replacement.
Ongoing follow-up with the Structural Heart Team.

Treatment recommendations will be individualized based on your symptoms, valve anatomy, and overall health.

When Should I Call My Doctor?

Contact your doctor immediately if you experience:

Increasing shortness of breath.
Chest pain.
Persistent bleeding or swelling at the catheter insertion site.
Palpitations or rapid heartbeat.
Leg swelling.
Sudden fatigue or weakness.
Any new or worsening symptoms.

Seek emergency medical attention immediately if you develop severe chest pain, stroke symptoms, difficulty breathing, or loss of consciousness.

Why Choose RS Abdi Waluyo for Transcatheter Mitral Valve Repair?

At RS Abdi Waluyo, our Structural Heart Program provides comprehensive, minimally invasive treatment for patients with complex mitral valve disease using advanced technology and internationally accepted treatment standards.

Our TMVr program offers:

Advanced Hybrid Catheterization Laboratory (Hybrid Cath Lab) equipped with state-of-the-art fluoroscopic imaging and real-time 3D Transesophageal Echocardiography (3D TEE).
Experienced Structural Heart specialists, including interventional cardiologists, cardiac surgeons, imaging cardiologists, and cardiac anesthesiologists.
Comprehensive Heart Team evaluation, ensuring every patient receives an individualized treatment strategy.
Minimally invasive treatment that avoids open-heart surgery in appropriately selected patients.
Reduced procedural risk, shorter hospital stay, faster recovery, and earlier return to normal activities.
Comprehensive care, from diagnosis and advanced imaging to intervention, rehabilitation, and long-term follow-up.
A patient-centered approach focused on safety, precision, clinical excellence, and improved quality of life.

By combining advanced structural heart expertise, Hybrid Cath Lab technology, and multidisciplinary collaboration, RS Abdi Waluyo provides world-class Transcatheter Mitral Valve Repair, offering patients with severe mitral regurgitation a safe, effective, and less invasive alternative to conventional open-heart surgery.