Mitral Valve Repair and Replacement Procedures
Overview
The mitral valve is one of the four main valves in the heart. It sits between the left atrium and left ventricle. This valve helps blood move in the correct direction through the heart. When the mitral valve does not close or open as it should, it causes mitral valve disease. This can lead to blood leaking backward or not moving as easily.
To treat this issue, doctors may recommend a repair or a full replacement of the valve. Surgeons perform this surgery either through open-heart surgery or a less invasive technique. The decision depends on how badly the valve is damaged and the patient’s overall health.
Key Points:
- Mitral valve disease affects heart function and blood flow.
- Repair is frequently preferred over replacement to preserve the integrity of the natural valve.
- Treatment choice is based on valve condition and disease severity.
Treatment Methods
Several approaches exist for valve replacement and repair. Common types include:
- Annuloplasty: Surgeons fix or tighten the ring around a heart valve.
- Valvuloplasty: Surgeons use a balloon to stretch the valve that has become stiff.
Valve replacement options use either mechanical valves or tissue valves. These choices can affect long-term care. Surgeons can perform mitral valve repair through open surgery or less invasive methods. Some cases use transcatheter tools instead of traditional surgery.
Reasons for the Procedure
Surgeons most often perform mitral valve surgery to address problems that affect how the valve works. When the mitral valve does not function properly, it can lead to health issues that impact the whole body. The main reasons include:
- Valve Regurgitation: The valve does not close completely, causing blood to leak backward. Over time, this can lead to symptoms such as weakness, fatigue, or swelling (edema).
- Valve Stenosis: The valve is too narrow because the flaps become stiff or thick. It makes it harder for blood to move forward, which can cause shortness of breath, chest pain, and limit physical activity.
Other conditions that may require mitral valve surgery are:
| Condition | Common Symptoms | Why Surgery Is Needed |
|---|---|---|
| Mitral Regurgitation | Edema, tiredness, cough | Prevents heart failure, eases symptoms |
| Valve Stenosis | Shortness of breath, chest pain | Improves blood flow, relieves symptoms |
| Valve Insufficiency | Swelling, irregular heartbeat | Reduces risk of complications |
Some people need this procedure to help prevent future complications, such as heart failure. Others get surgery to improve quality of life when medicines no longer control symptoms or if other heart problems are being treated at the same time. In certain cases, doctors may recommend valve repair instead of replacement to lower the risk of problems like blood clots or the valve wearing out. This helps maintain better heart function over time.
Possible Dangers
Mitral valve repair or replacement surgery carries risks. These include bleeding, blood clots, infection, and stroke. Sometimes irregular heartbeats may occur. The new valve may not work as expected. Blood thinners and anesthesia can also cause side effects.
Getting Ready Before Surgery
Eating, Drinking, and Medicines
Before mitral valve surgery, patients work closely with their care team to review all current medicines. Patients should share if they have any allergies or past reactions to drugs. The care team tells patients when to stop eating or drinking, usually the night before the surgery. Some people may need to take certain medications on the surgery day, but only if the care team says it is safe. A table can help track key topics:
| Topic | Details |
|---|---|
| Medication list | Bring an up-to-date list |
| Food/drink restriction | Follow instructions given by the team |
| Allergies | Tell the team about any drug allergies |
Most patients also undergo tests such as an echocardiogram to get a clear picture of their heart’s condition. This test uses ultrasound and helps doctors plan the procedure. If there are any questions about medicines or tests, patients should ask before arriving at the hospital.
What to Pack and Wear
For comfort and preparation, patients should bring loose clothes, a list of their medicines, and any special care items like glasses or hearing aids. Patients should pack items for personal care such as a toothbrush, brush or comb, and shaving kit.
Bringing something relaxing, such as a book or music, can help while in the hospital. It is best not to wear jewelry, nail polish, or contact lenses on the day of surgery. Patients should also bring a copy of their advance directive, if they have one. This helps guide their care if they are unable to speak for themselves.
What You Can Expect
In Preparation
Before the procedure begins, hospital staff usually remove hair on the chest area and clean the skin with a special soap to lower the chance of infection. Medical staff give medications to ensure patients are fully asleep during the operation. For safety, the team connects a heart-lung bypass machine to support blood flow while the heart is stopped.
Steps During Surgery
Surgeons may use several techniques to repair or replace the mitral valve:
Conventional Open-Heart Surgery: The surgeon creates a larger incision through the center of the chest to get direct access to the heart and mitral valve.
Minimally Invasive Approaches: Surgeons make smaller cuts. This method may allow for less pain, a shorter hospital stay, and a faster recovery compared to traditional open-heart surgery. Surgeons with specialized training at well-equipped hospitals perform this approach.
Robot-Assisted Procedures: Surgeons use robotic arms to perform surgery with high precision through tiny openings, adding flexibility and accuracy to the procedure.
Catheter-Based Treatments: Doctors insert a thin tube (catheter) through a blood vessel to reach the heart. Special clips, plugs, or valves can be guided through the catheter to repair or replace the mitral valve without making large chest incisions.
| Surgical Method | Incision Size | Potential Benefits |
|---|---|---|
| Open-heart surgery | Large | High visibility and control |
| Minimally invasive surgery | Small | Smaller scars, less pain, quicker recovery |
| Robot-assisted surgery | Very small | Enhanced precision |
| Catheter-based procedure | No chest incision | No large scars, less trauma |
Approaches to Mitral Valve Fix
Surgeons often prefer mitral valve repair when possible, as it keeps the patient’s own valve. Repair techniques include:
- Closing small holes in the valve.
- Rejoining the flaps of the valve.
- Trimming away excess tissue to help the valve close tightly.
- Repairing or replacing damaged cords that help hold the valve.
- Separating stuck-together valve flaps.
- Strengthening or reshaping the tissue ring (annulus) around the valve.
Common Repair Types
Annuloplasty: Surgeons tighten or strengthen the ring that circles the valve, either alone or with other methods.
Balloon Valvuloplasty: Surgeons use a balloon attached to a catheter to widen a narrowed mitral valve opening. The balloon is inflated to stretch the valve, then it is deflated and removed.
Mitral Clip Procedure: Doctors thread a catheter from the groin to the heart. A special clip at the end is attached to the valve to fix leaks, especially if a patient is not a candidate for standard surgery.
Repair Options Table
| Repair Method | Technique | Best For |
|---|---|---|
| Annuloplasty | Tightening the valve ring | Weak or stretched annulus |
| Valvuloplasty | Balloon widens narrowed opening | Narrow, stiff valve |
| Mitral clip | Clip placed to fix a leak | Severe leakage, not surgery candidate |
About Mitral Valve Replacement
If the valve cannot be fixed, the surgeon replaces it. The surgeon removes the old valve and installs a new one made from metal or biological tissue. Tissue valves may be made from the heart of a cow, pig, or another person. Sometimes, if a tissue valve inside the heart stops working, a new valve can be placed inside the old one using a thin tube (catheter). This is often called a “valve-in-valve” or transcatheter valve replacement.
| Replacement Type | Material | Key Features |
|---|---|---|
| Mechanical valve | Metal | Lasts long, requires medication to thin blood |
| Biological valve | Animal or human tissue | May not last as long as metal valves, fewer blood-thinning medicines needed |
| Valve-in-valve | New valve inside old tissue valve (via catheter) | Minimally invasive, usually for failing tissue valves |
What Happens Afterward
After surgery, patients remain in the hospital for several days. The length of stay depends on their health and how the surgery was done. During this time, the medical team:
- Monitors blood pressure, breathing, and heart rate.
- Provides medicine and fluids with an IV.
- Delivers oxygen if needed.
- Manages pain with medications.
- Uses tubes to remove urine and fluids from the body.
Hospital Care Checklist
- Slowly increasing how much a patient moves each day.
- Taking short walks and doing simple breathing exercises.
- Giving clear directions on caring for the surgical wound.
- Explaining which medicines to take, how much, and when.
- Teaching signs of infection and when to call the doctor.
After leaving the hospital, the care team tells the patient when regular activities like work, driving, or exercise can be restarted.
Key Recovery Points
- Follow up with the doctor for check-ups.
- Take all medication as prescribed.
- Watch for symptoms like fever, unusual pain, swelling, redness, or drainage from the incision.
- Gradually increase daily activities as advised.
Having clear instructions and support helps recovery after mitral valve repair or replacement. Each patient gets a care plan suited to their specific needs.
Outcomes
Mitral valve repair and replacement surgeries help lessen the symptoms caused by valve disease. Many patients experience better daily function and improved quality of life after surgery. There are differences in the long-term outcomes and aftercare.
If surgeons use a mechanical valve for replacement, patients must take daily blood thinning medicine to avoid blood clots. Biological valves are not as durable as mechanical valves and may need to be replaced after several years. Mechanical valves often last for many years without much wear.
Patients need regular doctor visits to check on the health of the new or repaired valve. Cardiac rehabilitation is often recommended. This program can help patients regain strength, improve fitness, and adjust to new routines. Tips for recovery and long-term heart health include:
- Not using tobacco products
- Exercising regularly
- Eating healthy foods
- Managing stress
- Maintaining healthy weight
- Keeping blood pressure under control
- Getting enough sleep
These habits can help support recovery time and promote the best possible results after heart valve procedures.
