NICE has been notified about this procedure and it is part of its work programme. The Interventional Procedures Advisory Committee (IPAC) will consider this procedure 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 1791
Description The procedure is usually done with the patient under general anaesthesia and using imaging guidance including fluoroscopy, angiography and transoesophageal echocardiography. Prophylactic antibiotics and anticoagulants are given before and during the procedure. Temporary peripheral extracorporeal circulatory support (usually through the femoral vessels) is sometimes used. The mitral valve is accessed surgically through an apical puncture of the left ventricle using an anterior or left lateral mini thoracotomy (transapical approach). A guidewire is placed across the existing native mitral valve and into a pulmonary vein. A balloon catheter delivery system is then advanced over the guidewire into the left atrium. The inner diameter of the mitral valve annulus is measured using transoesophageal echocardiography to establish the size of bioprosthetic valve needed. Using the delivery system, the bioprosthetic valve is then introduced, manipulated into position (to align the valve with the mitral annulus) and slowly deployed within the surgically implanted mitral valve ring under fluoroscopic and echocardiographic guidance. Often, rapid ventricular pacing is used to reduce movement of the heart. After valve deployment, the catheter delivery system, guidewires and pacing wires are removed from the left ventricle and the left ventricular puncture and chest incisions are closed. Valve performance is then assessed using echocardiography and fluoroscopy.

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