Mitral Valve Replacement: Procedure Details and Recovery

What is Mitral Valve Replacement?

Mitral valve repair is a surgical procedure performed to address issues with the mitral valve, a valve located between the left atrium and left ventricle of the heart. It is a treatment option for individuals diagnosed with mitral valve disease, aiming to restore proper valve function. While open-heart surgery is typically required for mitral valve repair, advancements in technology have led to the development of alternative procedures such as minimally invasive repair and percutaneous interventions.

When a person has severe mitral valve disease, their doctor may recommend either repairing or replacing the damaged valve. Repair is generally favoured over replacement, particularly when the valve leaks, as it offers more benefits and involves fewer risks. The preservation of the individual’s own valve is preferred whenever possible. However, in some instances, valve replacement may be the most suitable or only option.

It is essential for individuals scheduled for mitral valve repair to understand the reasons for the surgery and what to expect during and after the procedure. Like all heart surgeries, mitral valve repair carries risks, but advancements in medical technology have contributed to making the surgery safer and more effective.

In addition to the traditional open-heart surgery approach, some individuals may be eligible for alternative procedures, such as minimally invasive mitral valve repair or percutaneous interventions. These options are considered based on various factors, including age and overall health condition. Consulting with a doctor is crucial to determine the most appropriate valve repair method for each individual.

Mitral valve repair is vital in improving the heart’s function and enhancing overall cardiovascular health. By addressing issues with the mitral valve, this procedure can alleviate symptoms, restore normal blood flow, and promote a better quality of life for individuals with mitral valve disease.

Conditions Treated with Mitral Valve Repair

Mitral valve repair is primarily used to treat the following conditions:

• Mitral valve regurgitation: Also known as a “leaky valve,” occurs when the valve flaps do not close properly, leading to the backward flow of blood.
• Mitral valve stenosis: This condition involves the narrowing of the mitral valve opening, which restricts the blood flow through the valve.
• Mitral valve prolapse: This condition is characterised by the excessive flexibility or enlargement of the mitral valve leaflets, resulting in improper valve closure and potential regurgitation.

Importance of Mitral Valve Repair

Mitral valve repair is performed to address issues with the valve and mitigate the risk of complications. The mitral valve acts as a gateway between the left atrium and ventricle, allowing oxygenated blood to flow from the lungs to the rest of the body. When the valve is not functioning correctly, it can lead to heart and lung damage over time. Repairing the valve through surgery can help prevent or delay such complications.

Preparation for Mitral Valve Repair

Before undergoing mitral valve repair, patients will need to prepare for the surgery. This may involve following specific instructions from the doctor, such as:

• Collaborating with the doctor to quit smoking.
• Using antimicrobial soap for a thorough wash the night before the surgery.
• Taking prescribed medications on the day of the surgery.
• Fasting from food and drink after a designated time on the day of the surgery.

The Mitral Valve Repair Procedure

During mitral valve repair, a surgeon will address one or more issues with the valve. The specific surgical techniques used may vary, but the general steps of the procedure typically include:

• Administration of anaesthesia to induce a deep sleep during the surgery.
• Connection to a cardiopulmonary bypass machine, which temporarily takes over the heart and lung functions.
• Creation of an incision in the chest, the size and location of which depend on the surgical approach chosen. Options include full sternotomy (midline chest incision), partial sternotomy (smaller chest incision), right thoracotomy (incision between ribs), or robotic-assisted method (multiple small incisions).
• Placement of an annuloplasty ring around the valve, providing support and restoring its shape.
• Utilization of additional surgical techniques to repair the mitral valve as necessary.
• Evaluation of the success of the repair, with adjustments made if required.
• Disconnection from the bypass machine, allowing the heart and lungs to resume their normal function.
• Performance of a transesophageal echocardiogram to assess the repaired valve and confirm the success of the procedure.

Recovery After Mitral Valve Repair

Following mitral valve repair surgery, the recovery process typically involves:

• Spending one to two days in the intensive care unit (ICU), where vital signs and overall condition are closely monitored.
• Continuing recovery in a hospital room for several additional days.
• Participation in cardiac rehabilitation to aid in the recovery and improve overall heart health.
• Learning how to care for the incision site upon returning home.

On average, patients need to remain in the hospital for approximately one week after mitral valve repair surgery.

Advantages of Mitral Valve Repair

• Mitral valve repair offers several advantages over valve replacement, including:
• Increased chances of survival and a longer lifespan after surgery.
• Improved quality of life.
• Better preservation of heart function.
• Lower risk of complications such as stroke and endocarditis.
• Avoidance of long-term use of blood thinners (anticoagulants).

Whenever possible, doctors recommend mitral valve repair over replacement, especially for mitral valve regurgitation. However, replacement surgery may be more suitable in certain situations due to its shorter duration and simpler procedure. Consulting with a doctor can help determine the most appropriate option for each individual.

Complications of Mitral Valve Repair

Like any heart surgery, mitral valve repair carries potential complications, which may include:

• Arrhythmias: Irregular heart rhythms.
• Bleeding: Excessive or prolonged bleeding.
• Heart block: A disruption in the electrical signals that control heart contractions.
• Heart failure: Inadequate pumping ability of the heart.
• Infection: Surgical site or bloodstream infections.
• Stroke: Impaired blood flow to the brain.

It is essential to discuss the potential risks and complications with the doctor before undergoing mitral valve repair.

Who to consult?

It is crucial to consult with a qualified healthcare professional, such as a cardiologist or cardiac surgeon, who can evaluate your specific condition, discuss the potential risks and benefits, and provide personalised information regarding the seriousness, life expectancy, and success rate of mitral valve replacement in your particular case.

People also ask

1. How serious is a mitral valve replacement? 

Mitral valve replacement is a major surgical procedure and should be taken seriously. It involves the removal of the diseased mitral valve and its replacement with a mechanical valve or a biological (tissue) valve. As with any heart surgery, there are risks involved, including complications such as bleeding, infection, arrhythmias, blood clots, and potential damage to surrounding structures. However, the seriousness of the procedure is relative to the individual’s overall health, the severity of the mitral valve condition, and the skill of the surgical team.

2. How long is life after mitral valve replacement? 

The life expectancy and quality of life after mitral valve replacement can vary depending on various factors, including the individual’s overall health, age, presence of other medical conditions, and the success of the surgery. Generally, with a successful mitral valve replacement and proper post-operative care, most individuals can lead a normal and active life. However, it is essential to follow the healthcare provider’s recommendations, including taking prescribed medications, attending regular check-ups, and maintaining a heart-healthy lifestyle to optimise long-term outcomes.

3. Can you replace the mitral valve without open-heart surgery?

 In some instances, it is possible to replace the mitral valve without traditional open-heart surgery. These procedures are known as minimally invasive or percutaneous mitral valve interventions. They involve accessing the mitral valve through small incisions or catheters inserted through blood vessels, thus avoiding the need for a large chest incision. Minimally invasive techniques can include transcatheter mitral valve replacement (TMVR) or repair (TMVr). However, not all patients are candidates for these procedures, and the decision depends on individual factors such as the specific mitral valve condition and the expertise of the medical team.

4. What is the success rate of mitral valve replacement?

The success rate of mitral valve replacement depends on various factors, including the underlying condition, the patient’s overall health, the surgical technique used, and the expertise of the surgical team. Generally, mitral valve replacement has a high success rate, with a significant improvement in symptoms and long-term outcomes. According to studies, the short-term survival rate after mitral valve replacement is typically over 95%. However, it is essential to note that each case is unique, and outcomes can vary. The healthcare provider will assess the situation and provide a personalised prognosis based on the individual’s circumstances.