Transcatheter Mitral Valve Replacement (TMVR)

As people age, complex surgery often becomes too risky. Many have a higher risk of complications during or after surgery because of pre-existing conditions or other age-related factors. University Hospitals Harrington Heart & Vascular Institute offers a comprehensive range of transcatheter mitral valve replacement (TMVR) and repair options for high-risk patients with mitral valve regurgitation and mitral valve stenosis or patients who are not ideal for TEER.

Types of TMVR

In traditional open heart surgery, the heart is accessed through a large incision in the chest. In TMVR procedures, the surgeon reaches the heart with a thin flexible tube (catheter) inserted through a small incision in the leg, groin or chest, without the need to open your chest.

The TMVR procedures performed at UH include:

• Mitral valve-in-ring: For high risk patients with severe mitral regurgitation and/or stenosis who have had prior surgical mitral valve repair, we can implant a transcatheter valve without open heart surgery.
• Mitral valve-in-valve: Transcatheter valves can also be implanted inside of failed replacement mitral valves for high risk patients.

The Apollo Trial

The Apollo clinical trial offers a less invasive option for treating mitral regurgitation, currently in development at UH Harrington Heart & Vascular Institute, the only program in Northeast Ohio to offer this technology. Patients with severe mitral regurgitation symptoms who are not high risk for open surgery will receive either traditional open heart mitral valve replacement surgery or a novel TMVR procedure. In addition, patients who are higher risk for open surgery may have the opportunity of being treated with TMVR through the trial.

The Apollo trial is testing the Intrepid® transcatheter mitral valve replacement system, which is delivered through a catheter inserted between the ribs to access the heart. The new replacement valve is expanded directly into the malfunctioning mitral valve.

Other TMVR Options

Eligible patients at UH Harrington Heart & Vascular Institute also have access to other TMVR technologies that are under clinical investigation, including:

• Mitral valve-in-MAC: For patients with severe mitral regurgitation and/or stenosis associated with severe mitral valve calcification, we use the transcatheter technique to implant a replacement valve. This may reduce the risks associated with heart failure and improve quality of life in patients too weak for open heart valve replacement.
• AltaValve: This first-in-kind TMVR prosthetic heart valve is engineered to precisely conform to a patient’s anatomy. Created with a 3D printer, AltaValve is designed to reduce complications by eliminating many of the problems associated with other TMVR technologies.

To date, no TMVR procedures are approved by the FDA for native mitral valve replacement. The Apollo study and related research to develop TMVR technology can lead to significant improvements and expanded options for the treatment of mitral valve regurgitation and stenosis.

Why Choose UH Harrington Heart & Vascular Institute?

UH Harrington Heart & Vascular Institute serves Northeast Ohio communities and beyond with award-winning heart and vascular expertise. We are recognized as a best-in-class choice by patients and healthcare providers. Our heart and vascular specialists consistently earn high ratings on HCAHPS patient experience surveys and provider review sites like Healthgrades and RateMDs. In addition to their clinical practice, our physicians are advancing the field of cardiovascular medicine and surgery by leading nationally funded clinical trials.