Mitral valve repair and mitral valve replacement
Mitral valve repair and mitral valve replacement are types of surgery to fix or replace a leaky or stiff mitral valve in the heart. The mitral valve is between the left heart chambers (left atrium and left ventricle).
Mitral valve repair and mitral valve replacement may be done as an open-heart surgery procedure or as minimally invasive heart surgery. Sometimes a mitral valve problem may be treated with a catheter-based procedure. The specific procedure used depends on the severity of your mitral valve disease and whether it's getting worse.
Why it's done
Surgery or another procedure to repair or replace a mitral valve may be done if you have mitral valve disease such as:
- Mitral valve regurgitation. The flaps (leaflets) of the mitral valve don't close tightly, causing blood to leak backward. Mitral valve regurgitation is common in people with mitral valve prolapse. Mitral valve repair surgery is recommended if you have severe mitral valve regurgitation symptoms.
- Mitral valve stenosis. The valve leaflets become thick or stiff, and they may fuse together. This causes the valve to become narrowed and reduces blood flow through the area.
If mitral valve disease is mild, your health care provider may first suggest regular checkups to monitor your heart health. You may be prescribed medications to manage symptoms.
Sometimes mitral valve repair or mitral valve replacement is done even if you're not having symptoms. Research has found that performing surgery in some people with severe mitral valve regurgitation who aren't having symptoms — rather than monitoring the condition — can improve long-term outcomes.
For people with mitral valve disease, health care providers may often recommend repairing the mitral valve when possible, as it preserves the mitral valve and may preserve heart function.
Mitral valve repair may be done to avoid complications that can occur with mitral valve replacement, such as blood clots due to mechanical valves and biological tissue valve failure.
Possible risks of mitral valve repair and mitral valve replacement surgery include:
- Blood clots
- Malfunction of the replacement valve
- Irregular heartbeats (arrhythmias)
How you prepare
Before mitral valve repair or replacement, an echocardiogram and other tests may be done to get more details about your heart condition.
Your care providers will review what to expect during surgery and discuss any concerns you may have.
As you prepare for mitral valve repair or replacement, it can be helpful to talk to your loved ones about your hospital stay and what help you may need when you return home. Your care providers will give you specific instructions to follow during your recovery at home.
Food and medications
Talk to your health care providers about:
- The medications you take and when or if you can take them before surgery
- When you should stop eating or drinking the night before the surgery
- Allergies or reactions you have had to medications
Clothing and personal items
Your care providers may recommend that you bring several items to the hospital, including:
- A list of your medications
- Eyeglasses, hearing aids or dentures
- Personal care items, such as a brush, a comb, a toothbrush and shaving equipment
- Loosefitting, comfortable clothing
- A copy of your advance directive, if you have one
- Items that may help you relax, such as portable music players or books
During surgery, avoid wearing:
- Contact lenses
- Nail polish
What you can expect
Surgery to repair or replace the mitral valve is done at a hospital by a heart (cardiac) surgeon.
If you need heart surgery for another condition in addition to mitral valve disease, the surgeon may perform both surgeries at the same time.
You'll receive medication to put you into a deep sleep during the procedure (general anesthesia). You'll be connected to a heart-lung bypass machine, which keeps blood moving through your body during the procedure.
Mitral valve repair or replacement may involve:
- Open-heart surgery, which involves a cut (incision) in the chest.
- Minimally invasive heart surgery, which uses smaller incisions in the chest. Minimally invasive heart surgery may involve a shorter hospital stay, quicker recovery and less pain than open-heart surgery. Minimally invasive heart surgery generally should be done at medical centers with care providers experienced in performing such surgery.
- Robot-assisted heart surgery, a type of minimally invasive surgery in which the surgeon uses robotic arms to perform the same movements used in open-heart surgeries.
- Catheter-based procedure, which is done by a heart doctor in the catheterization lab (interventional cardiologist). This type of treatment involves inserting a thin, flexible tube (catheter) in a vein and guiding it to the heart. The catheter may be used to deliver tools to repair or replace the mitral valve.
Mitral valve repair
During mitral valve repair surgery, a surgeon may:
- Patch holes in a heart valve
- Reconnect the valve leaflets
- Remove excess tissue from the valve so that the flaps can close tightly
- Repair the structure of the mitral valve by replacing cords that support it
- Separate valve leaflets that have fused
Other mitral valve repair procedures include:
- Annuloplasty. Surgeons tighten or reinforce the ring around the valve (annulus). Annuloplasty may be done alone or with other techniques to repair a heart valve.
- Valvuloplasty. Also called balloon valvotomy, this catheter procedure is used to repair a mitral valve with a narrowed opening. The doctor inserts a catheter with a balloon on the tip into an artery in your arm or groin and guides it to the mitral valve. The balloon is inflated, widening the mitral valve opening. The balloon is deflated, and the catheter and balloon are removed.
- Mitral valve clip. In this procedure, the surgeon guides a catheter with a clip on its end to the mitral valve through an artery in the groin. The clip is used to fix a torn or leaky mitral valve leaflet. Your health care provider may recommend this option if you have severe mitral valve regurgitation and are not a good candidate for mitral valve surgery.
Mitral valve replacement
During mitral valve replacement, the heart surgeon removes the mitral valve and replaces it with a mechanical valve or a valve made from cow, pig or human heart tissue (biological tissue valve).
Sometimes, a catheter procedure may be done to insert a replacement valve into a biological tissue valve that is no longer working properly. This is called a valve-in-valve procedure.
After mitral valve repair or replacement surgery, you'll generally spend a day or more in the intensive care unit (ICU). How long you'll stay in the ICU and hospital depends on your specific condition and surgery.
During your hospital stay, you may receive:
- Fluids and medications through an IV
- Pain medication
Tubes are used to drain urine from the bladder and fluid and blood from the chest. Your care providers will frequently check your blood pressure, breathing and heart rate.
After leaving the ICU, you'll usually be moved to a regular hospital room for several days. If you've had a transcatheter procedure, you'll typically stay in the hospital at least overnight but may not need to be in the ICU. With this approach, there are no tubes needed to drain fluid or blood from the chest.
As you recover in the hospital you'll be asked to:
- Gradually increase activity
- Take longer and longer walks in the hospital
- Do breathing exercises
You'll receive instructions to follow during recovery, which usually includes the following details:
- How to care for your incisions
- What medications you should take and when
- How to manage pain and other side effects
- The signs and symptoms of infection and when to call your health care provider
After mitral valve repair or mitral valve replacement, your health care provider will tell you when you can safely return to daily activities, such as working, driving and exercise.
Mitral valve repair and replacement surgery may help reduce symptoms and improve quality of life in people with mitral valve disease.
If you had mitral valve replacement with a mechanical valve, you'll need blood thinners for life to prevent blood clots. Biological tissue valves break down (degenerate) over time and usually need to be replaced.
Regular health checkups are needed to make sure the new or repaired valve is working properly. Your care provider may recommend a program of education and exercise to help you improve your health and recover after heart surgery. This type of program is called cardiac rehabilitation.
Following a healthy lifestyle is important to heart health before and after mitral valve surgery. A healthy lifestyle includes:
- Not smoking
- Getting regular exercise
- Eating a healthy diet
- Managing stress
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