TMVR Explants: What Should Patients Know?
Written By: Allison DeMajistre, BSN, RN, CCRN
Medical Expert: Dominic Emerson, MD, Cardiac Surgeon, Cedars-Sinai, Los Angeles, California
Reviewed By: Adam Pick, Patient Advocate, Author & Website Founder
Published: July 31, 2026
Thousands of patients have undergone transcatheter mitral valve repair or replacement (TMVR) over the last 10 to 15 years. The procedure is minimally-invasive and performed without the need for a heart bypass machine or sternal incision. In most cases, patients recover more quickly with a short hospital stay.
Even with the success of these transcatheter procedures, the mitral valve has complex structural components that may continue to develop further leakage and recurrent mitral regurgitation. We receive many questions on this topic, with patients wanting to know more about further interventions and possible explant procedures.
We were recently at Cedars-Sinai Medical Center in Los Angeles, California, where he met with Dr. Dominic Emerson, a leading mitral valve surgeon. Dr. Emerson is a mitral valve specialist who offers helpful insights into TMVR procedures and what patients can expect when they need an explant.
Video available online at:
https://www.youtube.com/watch?v=BKU3s-slfEM
Key Learnings About TMVR Explants
Here are the important insights shared by Dr. Emerson:
The types of TMVR procedures. "We're seeing more and more in the minimally invasive, transcatheter-based mitral valve space," said Dr. Emerson. "Interventional cardiologists, often in conjunction with surgeons, do these procedures to repair or replace the mitral valve without surgery, and they cover a broad base of things. There are complete mitral valve replacements, which are less common but an important part of what happens. Then there are transcatheter valve repairs, which can be either Transcatheter Edge-to-Edge Repair (TEER) or the MitraClip."
It's essential to have an experienced heart team when considering an explant. Dr. Emerson explained, "The number of clips or TEERs has grown significantly. From a surgical standpoint, if we must address one of those valves that have already had an intervention, it's very difficult to achieve a good repair. It's also important to know that we prefer to repair the mitral valve whenever possible rather than replace it, as long-term outcomes are better. Surgically re-repairing a valve that has had a TEER is very challenging, and the repair rates are very low."
Dr. Emerson stressed that when patients with a prior TEER and a leaking valve require intervention, it's essential to seek care at a "Center of Excellence" experienced in device removal and repair. "Whether through a mid-sternotomy or from the side using the robot in a minimally invasive way, it's important to go to a team of people with a lot of experience."
Thanks Dr. Emerson and Cedars-Sinai Medical Center!
On behalf of all the patients in our community, thank you, Dr. Dominic Emerson, for everything you and your team are doing at Cedars-Sinai Medical Center in Los Angeles, California!
Related links:
Keep on tickin,
Adam
P.S. For the deaf and hard-of-hearing members of our patient community, we have provided a written transcript of our interview with Dr. Emerson below.
Written by Adam Pick
Patient & Website Founder
Written by Adam Pick - Patient & Website Founder
Adam Pick is a heart valve patient and author of The Patient's Guide To Heart Valve Surgery. In 2006, Adam founded HeartValveSurgery.com to educate and empower patients. This award-winning website has helped over 10 million people fight heart valve disease. Adam has been featured by the American Heart Association and Medical News Today.
Video Transcript:
Adam Pick: Hi everybody. It's Adam with HeartValveSurgery.com, and we're in Los Angeles, California at Cedars-Sinai Medical Center. I'm thrilled to be joined by Dr. Dominic Emerson, who is a leading cardiac surgeon. Dr. Emerson, it is great to see you again, and thanks for being with me today.
Dr. Dominic Emerson: Thanks for having me.
Adam Pick: We were just having a great conversation. You are a mitral valve specialist. We're getting questions from patients all about TMVR Explants. Can you talk about TMVR explants and what should patients know about it?
Dr. Dominic Emerson: That's a great question. We're seeing more and more in the minimally invasive, transcatheter based mitral valve space. And what that means is interventions that interventional cardiologists do, often in conjunction with surgeons, to repair or replace the mitral valve without surgery.
That actually covers a broad base of things. There are, complete valve replacements of the mitral valve, which are done transcatheter. Those are much less common, but they're an important part of things that happen. And then there are transcatheter valve repairs, which you'll see as either TEER, which is Transcatheter Edge-to-Edge Repair, or you'll see the MitraClip.
And that was just the first device on market. So, a lot of people just say, I'm getting a clip. The number of these clips or the TEERs that are done has grown significantly. From a surgical standpoint, if we have to address one of those valves that have been intervened on before, it's very, very difficult to get a good repair.
And remember that when we intervene on the mitral valve, the important things we want to do wherever possible, a mitral valve repair rather than a replacement, because we know that the outcomes long term are going to be better. Re-repairing a valve that's had tear done surgically is really, really challenging.
The repair rates for that are very low. Nationally, we've looked at those numbers and so I think that when you go, if you're in that specific position already, if you're a patient with a prior TEER, it's now having leak has to have something done that going to a “Center of Excellence” that has experience with the removal of these devices and potentially repairing your valve, whether that be through a sternotomy coming to the middle, or from the side using the robot in a minimally invasive way.
I think it's important to go to people that have, have a lot of experience with it.
Adam Pick: Great. Well, thanks for the education about TMVR explants and Dr. Emerson, on behalf of all the patients at HeartValveSurgery.com, people all over the world, thanks to you for everything you and your team are doing here at Cedar-Sinai. Thanks for being with me today.
Dr. Dominic Emerson: Thank you.
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