Is mitral valve replacement really safe?


Is mitral valve replacement really safe?
Lokesh S
Neurosurgery
Is mitral valve replacement really safe?

Is mitral valve replacement really safe?

Thane resident Mithulal Bafana said in a complained to Maharashtra medical council; The doctors had assured him that the new procedure —transcatheter mitral valve repair—was "200% safe" and his wife, would be back home in five days.


What is Transcatheter valve replacement?
Transcatheter valve replacement is minimally invasive surgical procedure which repairs the valve without removing the old, damaged valve. Instead, it wedges a replacement valve into the native valve’s place. The Trans catheter valve replacement procedure is performed using the transapical approach:  a minimally invasive surgical approach with a small incision in the chest and entering through a large artery in the chest or through the tip of the left ventricle (the apex) or transeptal approach.


Transcatheter aortic valve replacement (TAVR) is a well-established treatment option for patients with symptomatic severe aortic stenosis. Tran catheter mitral valve replacement (TMVR) is relatively new and the experience with transcatheter MVR remains at an early stage. In a recently published study, successful device implantation free of cardiovascular mortality, stroke, and device malfunction at 30 days was 86.6%.

Challenges in the TMVR:
I. Patients of mitral regurgitation(MR) are younger
II. The benefit of MV repair or replacement in patients with secondary MR is less pronounced.
III. Device specific challenges: The risk of left ventricular outflow (LVOT) obstruction, due to the bulkiness of the device
IV. Concerns related to the durability and the potential thrombogenicity of the bioprosthesis
V. The complexity of the mitral valve anatomy
VI. The constant movement of the mitral annulus and the basal part of the LV, which makes stable anchoring of the prosthesis challenging

Image source:mitraclip.com