TEER, or transcatheter edge to edge repair is a catheter-based procedure that providers repair of a leaking valve. In this case, the mitral valve which separates the upper left chamber and lower left chamber of the heart. This procedure is recommended for patients who have severe, symptomatic mitral regurgitation. It is best suited for patients who would be high risk for surgical intervention and/or are not responding well to medical therapy. Patients who have secondary or functional mitral regurgitation caused by heart failure are especially good candidates for this procedure, as there is little research to show patients with secondary mitral regurgitation benefit from open surgery to repair or replace the valve.

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Prior to procedure

Before you undergo a transcatheter tricuspid valve repair there are several appointments and tests you may be scheduled for including:

• TEE or transesophageal echocardiogram
• Coronary angiogram
• Consultation with Interventional Cardiologist - prior to procedure you will need to meet with the structural heart/valve specialist to discuss the risks and benefits to this procedure. Interventional cardiologists are the providers who complete the transcatheter valve repairs.
• Heart Failure Specialist visit - depending on the cause of your MR, the heart valve specialist who will complete your transcatheter mitral valve repair will recommend you meet with a heart failure specialist. Heart failure can be a contributing factor to this disease process and ensuring you are medically optimized and on the best medication regimen pre-procedure is crucial.
• Consultation with a Cardiothoracic Surgeon - even if transcatheter repair of your valve is recommended, it is still required that you meet with an open-heart surgeon. This provides you with a well-rounded recommendation and allows you to hear what your personal risk and benefit would be to surgically repairing or replacing your valve. It is also required by most insurance companies in order to move forward with your procedure.
• Dental clearance - a visit with your dentist is required to ensure you have no active infection or teeth that may become infected. If dental work is required, it is preferred to have this done prior to your procedure to decrease the risk of infection on your device or in the heart.
• Additional tests/appointments as needed - based on specifics of your case, comorbidities, etc. it may be recommended that you meet with additional specialists or have additional testing prior to undergoing transcatheter mitral valve repair.

Procedure overview

Once the work up process is complete and it is confirmed you are a good candidate for transcatheter mitral valve repair you can expect a 1–3-night stay in the hospital to complete your procedure. The procedure itself takes approximately 2 hours and is done under general anesthesia. During your procedure you will also have a TEE, or transesophageal probe placed for imaging.

During the procedure a puncture is made in the large vein in your leg, your femoral vein. A catheter is threaded up through the heart with the device on the catheter. Xray technology and contrast dye, along with the TEE images allow the interventional cardiologist to guide the catheter and device into the correct location. The device functions like a clip to pull the leaflets of your valve together, ultimately decreasing the amount of leaking across the valve. You may have other large bore catheters and intravenous sites placed during your procedure.

Risk and Benefits

Benefits to this procedure include:

• Improved quality of life and symptom reduction
• Minimal interruption to lifestyle, short hospital stay and recovery time
• Decreased risk of further complications related to severe mitral regurgitation (heart failure)
• For many patients this is the only procedure they will require to treat their mitral valve

Risks of this procedure include:

• Bleeding anywhere from the insertion site of the catheter up to and including the structures of the heart
• Detachment of the device and/or recurrence of severe mitral regurgitation
• Valve complications which may complicate or prevent later surgical repair
• Cardiac arrhythmias
• General post procedure complications such as infection, blood clots in the legs or lungs, stroke, pain, nausea/vomiting, etc.

Recovery

Once cleared for discharge you will have several follow up appointments with your structural heart team to ensure you are recovering well and that your device is functioning properly. This includes both echocardiogram imaging and visits with your provider. You will have activity restrictions for less than one week following your procedure and can typically resume normal routines following that. All patients are encouraged to work with cardiac rehab following valve repair or replacement.