Off-pump minimal access mitral valve repair by artificial chordae insertion to treat mitral regurgitation

When open-heart surgery and other mitral valve procedures are unsuitable

There are uncertainties about how well this procedure works or how safe it is. But there are few options to treat mitral regurgitation caused by mitral valve leaflet prolapse in adults when open-heart surgery and other mitral valve procedures are unsuitable. So, it can be done while more evidence is generated about how well the procedure works and how safe it. This means you will have regular appointments afterwards to check how well it is working or if it has caused problems.

When open-heart surgery or other mitral valve procedures are suitable

This procedure can only be done as part of a research study to treat mitral regurgitation caused by mitral valve leaflet prolapse in adults when open-heart surgery or other mitral valve procedures are suitable options. This is because there is not enough evidence to be sure how well the procedure works or how safe it is.

Your healthcare professional should talk to you about the research.

About the procedure

The mitral valve controls blood flow between the upper and lower left-sided chambers of the heart. If the mitral valve does not close properly, blood flows backwards through the valve (regurgitation) when the heart contracts. So, the heart must work harder to pump blood around the body. This can lead to heart failure. Mitral valve regurgitation can be caused by ruptured chordae (thin cord-like structures that connect the valve to small muscles on the inner wall of the heart).

In this procedure, which is done under general anaesthesia, a device is inserted into the mitral valve through a cut on the left side of the chest (minimal access). The device is used to insert artificial chordae, which help the valve to close properly. Stopping the heart and using a heart–lung machine is not needed for this procedure (off-pump). The aim is to reduce symptoms and improve quality of life.

Is this procedure right for me?

You should be included in making decisions about your care. See our webpage on shared decision making.

Your healthcare professionals should explain the risks and benefits of this procedure and how it is done. They should discuss your options and listen carefully to your views and concerns. They should offer you more information about the procedure. Your family or carers can be involved if you want or need them to be.

You will be asked to decide whether you agree (consent) to have the procedure. Find out more about giving consent to treatment on the NHS website.

Some questions to think about

• How many appointments will I need?
• What are the possible benefits? How likely am I to get them?
• What are the risks or side effects? How likely are they?
• Will I have to stay in hospital?
• What happens if it does not work or something goes wrong?
• What happens if I do not want the procedure?
• Are other treatments available?
• How long is recovery likely to take? When can I get back to normal activities?

Information and support

The NHS webpage on heart valve disease may be a good place to find out more.

The NHS website has information about NHS hospital services and referrals for specialist care.

• NICE's information on interventional procedures guidance explains what an interventional procedure is and how we assess it.
• NICE’s information on recommendations explains the types of recommendation we make.

Heart Valve Voice (email: info@heartvalvevoice.com) can give you advice and support.

You can also get support from your local Healthwatch.

ISBN: 978-1-4731-9291-1