The National Institute for Health and Care Excellence (NICE) issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on Transapical transcatheter mitral valve-in-valve implantation for a failed surgically implanted mitral valve bioprosthesis in December 2015. NICE is currently updating this guidance. The new guidance will be published shortly. Until then the NHS should continue to follow the recommendations outlined in the current version of the guidance. The Interventional Procedures Advisory Committee (IPAC) will consider this procedure review and NICE will issue an interventional procedures consultation document about its safety and efficacy for 4 weeks’ public consultation. IPAC will then review the consultation document in the light of comments received and produce a final interventional procedures document, which will be considered by NICE before guidance is issued to the NHS in England, Wales, Scotland and Northern Ireland.
Status In progress
Process IP
ID number 1070
Description Mitral valve replacement is where an artificial prosthetic valve (bioprosthetic or mechanical) is inserted by open heart surgery. It is most commonly done for severe symptomatic mitral regurgitation but may also be done in patients with severe mitral valve stenosis or a combination of both. Symptoms of severe mitral valve disease typically include shortness of breath, fatigue and palpitations (because of atrial fibrillation). Bioprosthetic valves have some advantages over mechanical valves, but they are more likely to degenerate and fail over time. This can result in severe stenosis or regurgitation, needing replacement of the bioprosthetic valve. The standard treatment for a failed bioprosthetic valve is repeat open heart surgery to replace the valve. Repeat open heart surgery is associated with a higher risk of morbidity and mortality than primary surgery. Transapical transcatheter mitral valve-in-valve implantation is a less invasive alternative when repeat open heart surgery is considered to have a high risk. It avoids the need for routine cardiopulmonary bypass and can be used to treat failed bioprosthetic mitral valves originally placed during open heart surgery.

Provisional Schedule

Expected publication 28 July 2021

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Key events during the development of the guidance:

Date Update
25 February 2021 - 25 March 2021 Interventional procedure consultation

For further information on how we develop guidance, please see our page about NICE interventional procedures guidance