Mitral Valve Repair or Replacement

Mitral valve repair and replacement are surgical procedures to address a damaged or diseased mitral valve, one of the heart's four valves responsible for regulating blood flow. The mitral valve ensures proper blood flow through the heart's left upper chamber, the main pumping chamber, and the left ventricle. During each heartbeat, the mitral valve opens to allow blood to flow from the left atrium to the left ventricle, closing to prevent backward flow when the heart contracts. Impairment of the mitral valve can disrupt blood flow, leading to increased strain on the heart.

Mitral Valve Replacement

Mitral Valve Replacement (MVR) involves replacing a damaged mitral valve with a new prosthetic valve. The mitral valve, located between the left atrium and the left ventricle, regulates blood flow within the heart. Conditions such as mitral stenosis and mitral regurgitation can result in valve malfunction, causing symptoms like fatigue, shortness of breath, and chest pain, which can progress to heart failure if left untreated.

Types of Mitral Valve Replacement

There are two main types of mitral valve replacement:

Traditional Mitral Valve Replacement (open-heart surgery): This standard procedure requires opening the chest to access the heart, removing the damaged valve, and replacing it with either a mechanical or biological valve. Mechanical valves are durable but require lifelong blood thinners, while biological valves, made from animal tissue, do not necessitate long-term blood thinners but may have a limited lifespan.
Minimally Invasive Mitral Valve Replacement: This less invasive method involves smaller incisions and specialized instruments to replace the valve, reducing the patient's recovery time and post-operative discomfort.

Mitral Valve Repair

Heart surgeons recommend mitral valve repair when possible. There are several types of mitral valve repairs:

Annuloplasty. Surgeons tighten or reinforce the ring around the valve. Annuloplasty may be done alone or with other heart valve repair methods.
Valvuloplasty. Also called balloon valvotomy, this treatment 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 the arm or groin and guides it to the mitral valve. The balloon is inflated. This makes the mitral valve opening larger. The balloon is deflated. The catheter and balloon are removed.
Mitral valve clip. A 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. This treatment may be recommended if you have severe mitral valve regurgitation and you cannot have other types of mitral valve surgery.

Benefits of a Mitral Valve Repair or Replacement

Mitral valve repair and replacement aim to restore proper blood flow and alleviate symptoms associated with mitral valve disease, potentially improving life expectancy. These procedures can be performed using traditional open-heart surgery or minimally invasive approaches.

Risks

Mitral valve repair and mitral valve replacement surgeries come with potential risks that include bleeding, blood clots, failure of the replacement valve, irregular heartbeats known as arrhythmias, infection, and the risk of stroke.

What to Expect

Before the procedure: Prior to the commencement of mitral valve surgery, a healthcare team member may remove any body hair from your chest area. A specialized soap is then applied to cleanse your skin, eliminating germs and reducing the risk of infection. General anesthesia is administered to induce a sleep-like state for the duration of the surgery. During the procedure, you are connected to a heart-lung bypass machine, ensuring continuous blood circulation throughout the body.

During the procedure: The approach during mitral valve repair and replacement surgery varies depending on the specific method. There are several techniques available:

Open-heart surgery involves a mid-chest incision to access the heart. A minimally invasive heart surgery utilizes smaller cuts, leading to potentially shorter hospital stays and quicker recovery times. Robot-assisted heart surgery employs robotic arms to mimic the movements of open-heart surgery. Additionally, catheter-based procedures involve using a long, thin tube to repair or replace the mitral valve with tools passed through the catheter. It is advisable to seek out medical centers with experienced doctors for minimally invasive and catheter-based heart valve surgeries. An example of a catheter-based procedure is transcatheter mitral replacement.

After the procedure: Following mitral valve repair or replacement surgery, patients typically undergo a few days of hospitalization, depending on individual health status and the specifics of the surgery performed.

Throughout your hospital stay, your medical team diligently monitors your vital signs, administers fluids and medications via IV, provides oxygen, and manages pain relief. You may have catheters for draining urine and fluids from your chest. Your care team assists you in gradually increasing your activity levels, taking walks within the hospital, and practicing breathing exercises.

Detailed instructions are given for your recovery period, covering wound care, medication schedules, pain management, symptom recognition for potential infections, and guidance on resuming daily activities like work, driving, and exercise as advised by your healthcare provider post-mitral valve surgery.

Results of Mitral Valve Repair or Replacement

Mitral valve repair and replacement surgery can alleviate symptoms of valve disease and enhance the overall quality of life. Patients with mechanical valve replacements must take blood thinners indefinitely to prevent blood clots, while biological tissue valves may require replacement due to gradual breakdown. Mechanical valves are designed for long-term durability.

Regular health check-ups are essential to monitor the functionality of the repaired or replaced valve. Healthcare professionals may suggest cardiac rehabilitation, a program combining education and exercise to aid post-surgery recovery and overall health improvement.

Adopting a healthy lifestyle before and after mitral valve surgery is crucial for heart health. This includes refraining from smoking, exercising regularly, maintaining a healthy weight, consuming nutritious foods while limiting salt and saturated fats, managing stress, controlling blood pressure, cholesterol, and blood sugar levels, and ensuring adequate sleep of 7 to 8 hours daily.