CPT® Code 0544T

1. Indications

Transcatheter mitral valve annulus reconstruction is indicated for patients experiencing mitral valve prolapse (MVP) and mitral regurgitation (MR) due to myxomatous degeneration or similar connective tissue disorders. The procedure is particularly suitable for individuals who are symptomatic and have demonstrated significant backflow of blood into the left atrium, leading to clinical manifestations such as heart palpitations, shortness of breath, or fatigue. It is also indicated for patients who may not be ideal candidates for traditional open-heart surgery due to comorbidities or other health concerns.

• Mitral Valve Prolapse (MVP) - A condition where the mitral valve leaflets do not close properly, leading to regurgitation.
• Mitral Regurgitation (MR) - The backflow of blood into the left atrium due to improper closure of the mitral valve.
• Myxomatous Degeneration - A connective tissue disorder causing thickening and elongation of the mitral valve leaflets and chordae tendineae.
• Symptomatic Patients - Individuals experiencing symptoms related to MVP or MR, such as palpitations or shortness of breath.
• High-Risk Surgical Candidates - Patients who may not tolerate traditional surgical interventions due to other health issues.

2. Procedure

The procedure begins with the placement of a percutaneous intravenous line in the femoral vein to access the venous system. Following this, a transseptal puncture is performed, which involves creating an opening in the septum between the right and left atria. This step is guided by transesophageal ultrasound to ensure accurate placement. Once the puncture is made, a transseptal steerable sheath is advanced over a guidewire into the left atrium. This sheath serves as a conduit for the subsequent delivery of the annulus reconstruction device.

• Step 1: Accessing the Heart - A percutaneous intravenous line is established in the femoral vein, allowing for vascular access to the heart.
• Step 2: Transseptal Puncture - A puncture is made in the septum between the atria, facilitated by transesophageal ultrasound guidance to ensure precision.
• Step 3: Advancing the Sheath - A steerable sheath is navigated through the puncture site into the left atrium, providing access for the implant delivery system.
• Step 4: Positioning the Device - The implant delivery system is advanced through the sheath into the left atrium, positioning the annulus reconstruction device near the anterolateral trigone.
• Step 5: Deploying the Anchors - The reconstruction device, which consists of an inner contraction wire covered with polyester fabric, is positioned and secured using deployable anchors that attach to the valve leaflets.
• Step 6: Adjusting the Device - A size adjustment tool is introduced through the delivery system, allowing for tightening of the wire within the reconstruction device until optimal valve function is achieved.
• Step 7: Finalizing the Procedure - The sheath and implant delivery system are removed, and if necessary, the septum is repaired with sutures. Finally, the percutaneous intravenous line is removed, and the skin is closed.

3. Post-Procedure

After the completion of the transcatheter mitral valve annulus reconstruction, patients are typically monitored for any immediate complications related to the procedure. Post-procedure care may include observation in a recovery area, where vital signs are closely monitored. Patients may experience some discomfort at the access site, which should be managed appropriately. Recovery time can vary, but many patients are able to resume normal activities within a few days, depending on their overall health and the complexity of the procedure. Follow-up appointments are essential to assess valve function and ensure that the reconstruction device is functioning as intended. Any signs of complications, such as infection or persistent regurgitation, should be promptly addressed by the healthcare team.