Mitral Valve Surgery
What is mitral valve surgery?
Mitral valve surgery repairs or replaces the mitral heart valve. Heart valves control blood flow through the four chambers of the heart. The mitral valve sits between the left atrium—or upper chamber—and the left ventricle—or lower chamber.
Another name for the mitral valve is the bicuspid valve because it has two leaflets—or flaps. The flaps open to allow blood to flow forward and close tightly to prevent blood from leaking backwards. When the valve becomes diseased or damaged, it can’t regulate this flow properly. Mitral valve surgery can correct this problem.
There are two main types of mitral valve surgery:
- Mitral valve repair fixes a diseased or damaged mitral valve. There are several types of valve repair surgeries, depending on the specific valve problem. Doctors may make the valve open wider (balloon valvuloplasty), fix holes or tears in a valve (patch leaflets), tighten valve openings (ring annuloplasty), or separate, remove or reshape valve tissue (commissurotomy, decalcification, and triangular resection).
- Mitral valve replacement removes a diseased or damaged mitral valve and replaces it with a new valve. New valves can either be mechanical or biological. Mechanical valves are man-made and consist of materials such as titanium or carbon. Biological—or tissue—valves can come from humans or animals, either pigs or cows
Why is mitral valve surgery performed?
Doctors may recommend mitral valve surgery when the valve no longer opens or closes properly. Reasons for mitral valve surgery include:
- Mitral valve regurgitation, which is when the valve doesn’t close all the way. This lets blood leak backwards instead of flowing forward. The most common cause of regurgitation is mitral valve prolapse, in which the leaflets are loose or floppy.
- Mitral valve stenosis, which is narrowing of the valve that prevents the valve from opening all the way. This prevents blood from flowing forward effectively. Stenosis can occur when leaflets become thick, stiff, or fused together.
If you have symptoms of mitral valve disease, your doctor may discuss surgery with you. Symptoms can include fatigue, shortness of breath, irregular heartbeats, and a heart murmur. However, doctors recommend surgery in some cases even without symptoms. When mitral valve disease is severe, surgery can be beneficial in the long-term, even if symptoms are not present. Doctors may also recommend mitral valve surgery regardless of symptoms or severity if you need heart surgery for another reason.
In most cases, doctors can repair the valve rather than replacing it. If repair isn’t possible, valve replacement may be necessary. Talk with your doctor about all risks and benefits of surgery and ask if you are a candidate for a minimally invasive procedure.
Who performs mitral valve surgery?
Cardiac surgeons and interventional cardiologists perform mitral valve surgery. A cardiac surgeon specializes in the surgical treatment of conditions of the heart and its blood vessels. Cardiac surgeons may also be known as heart surgeons, cardiothoracic surgeons, or cardiovascular surgeons. An interventional cardiologist specializes in diagnosing and treating conditions and diseases of the heart and blood vessels. They use nonsurgical, catheter-based procedures and specialized imaging techniques.
How is mitral valve surgery performed?
Mitral valve surgery takes place in a hospital using general anesthesia. General anesthesia is usually a combination of IV (intravenous) medicines and gases that put you in a deep sleep. You are not aware of the procedure and do not feel pain.
There are several surgical approaches to mitral valve surgery including:
- Catheter surgery may be an option for patients who are not candidates for other types of valve surgeries. Catheter surgery involves inserting a catheter through a blood vessel in your groin. The surgeon threads the catheter up to the heart until it reaches the mitral valve. The surgeon uses tiny instruments passed through the catheter tip to perform the repair or replacement. This type of surgery may only be available at certain medical centers.
- Minimally invasive surgery includes a few different techniques. It may involve a small 2- to 3-inch incision in your chest or several smaller incisions for endoscopic surgery. An endoscope is a thin, lighted instrument with a small camera. The camera transmits pictures to a computer screen your doctor uses to perform the surgery. Minimally invasive surgery causes less trauma to tissues. So, it generally has a shorter recovery time, fewer complications, and less pain than open surgical procedures.
- Robot-assisted surgery is a type of minimally invasive surgery. The robot provides magnified 3D images and uses tiny tools with much greater flexibility and dexterity than a human hand. This allows your surgeon to operate with more precision and control. This type of surgery may only be available at certain medical centers.
- Open surgery involves a 6- to 8-inch incision in your chest and cutting through the breast bone. This allows your surgeon to directly view and access the heart. With open-heart surgery, it generally takes longer to recover and has a higher risk of complications and more pain than minimally invasive surgery. Despite this, open-heart surgery may be a safer or more effective method for certain patients.
Talk with your doctor about all your surgical options. Consider getting a second opinion before making a final decision. Second opinions are valuable because they give you information. The consulting doctor may reinforce what you already know or give you new insights into your situation. In either case, it can help you feel more confident about your ultimate choice in surgery.
What to expect the day of your mitral valve surgery
In some cases, you may already be in the hospital before mitral valve surgery. If not, this is generally what happens the day of your surgery:
- You will change into a hospital gown and remove all jewelry. If possible, leave valuables at home or with a family member.
- You will talk with a preoperative nurse, who may perform a brief exam.
- You will talk with the anesthesiologist about your medical history and the type of anesthesia you will receive.
- A team member will start an IV and you may get a sedative to help you relax.
- Once you are in the operating room, the anesthesiologist will start general anesthesia. You won’t remember anything else until you wake up in the recovery room.
- Your surgery may involve cardiopulmonary bypass using a heart-lung machine. If so, it will temporarily take over the job of pumping oxygen-rich blood to your organs and tissues. This allows your surgeon to operate on a heart that is not beating and has no blood traveling through it.
- Your team will monitor and support your vital body functions throughout the procedure and during recovery.
What are the risks and potential complications of mitral valve surgery?
All surgeries involve risk and the possibility of complications. Issues can develop during the procedure itself or later during recovery. In some cases, complications can be serious and even life threatening.
General risks of surgery
The general risks of surgery include:
- Anesthesia reaction, such as an allergic reaction and problems with breathing
- Bleeding, which can lead to shock
- Blood clot, in particular a deep vein thrombosis (DVT) that develops in the leg or pelvis. A DVT can travel to your lungs and cause a pulmonary embolism.
Potential complications of mitral valve surgery
Almost all mitral valve surgeries are successful, but potential mitral valve surgery risks include:
- Heart arrhythmias
- Infection of the valve or dysfunction of the new valve in valve replacements
- Memory problems
- Post-pericardiotomy syndrome, which is a low-grade fever and chest pain for up to six months following open heart surgery.
Reducing your risk of complications
You can reduce your risk of certain complications by:
- Following activity, dietary and lifestyle restrictions and recommendations before your surgery and during recovery
- Informing your doctor if you are nursing or if there is any possibility of pregnancy
- Notifying your doctor immediately of any concerns, such as bleeding, fever, or increase in pain
- Taking your medications exactly as directed
- Telling all members of your care team if you have allergies
How do I prepare for mitral valve surgery?
The steps you take before surgery that can improve comfort and outcome. You can prepare for mitral valve surgery by:
- Answering all questions about your medical history and medications. This includes prescription medications, over-the-counter drugs, herbal supplements, and vitamins. It is a good idea to carry a current list of your medical conditions, medications, and allergies at all times.
- Losing weight if you are overweight through a healthy diet and safe exercise plan.
- Not eating or drinking before surgery as directed. This reduces the risk of complications, such as choking on stomach contents during deep anesthesia. You may have to reschedule surgery if you eat or drink too close to the start of the procedure.
- Stop smoking as soon as possible. Even quitting for a just few days can help prevent complications from poor healing that can occur with smoking.
- Taking or stopping medications exactly as directed. For mitral valve surgery, this may include not taking aspirin, ibuprofen (Advil, Motrin), and blood thinners.
Questions to ask your doctor
Consider making a list of questions to help you remember everything you want to ask your doctor. Questions you may have include:
- Why are you recommending mitral valve surgery? Are there any other treatment options I can try first?
- What type of mitral valve surgery are you recommending and why?
- How long will the surgery take? When will I be able to go home?
- What restrictions will I have after the surgery? When can I expect to return to work and other activities?
- What kind of assistance will I need at home?
- What medication plan should I follow before and after the surgery? How do I take my usual medications?
- Will I need cardiac rehab after surgery? If so, how long will I need it?
- How should I contact you? When should I see you in follow-up? Ask for numbers to call during and after regular hours.
What can I expect after mitral valve surgery?
It’s easier to plan and prepare for a successful recovery when you know what to expect.
How long will it take to recover?
After surgery, you will likely spend a day or more in an ICU (intensive care unit). As you recover, you may move to a regular hospital room outside the ICU. Typical hospital stays range from 3 to 7 days.
Recovery after major surgery is a gradual process. Many variables will determine how long it takes you to return to normal activities. This includes factors like your age, the specific procedure, and your general health. A cardiac rehab program can help you recover safely and more quickly. Cardiac rehab is a medically supervised program that usually lasts about three months. Full recovery after mitral valve surgery can take a few months.
Will I feel pain?
You will have pain after mitral valve surgery. Controlling pain is important for healing and a smooth recovery. It allows you to fully participate in your rehabilitation. Contact your doctor if you are in pain despite following your pain control plan or if your pain gets worse or changes in any way. It could be a sign of a complication.
When should I call my doctor?
For questions between appointments, contact your doctor’s office. However, you should call your doctor right away or seek immediate medical care if you have any of the following:
- Breathing problems or shortness of breath
- Chest pain, pressure or tightness
- Confusion or changes in level of alertness
- Drainage of pus, redness or swelling around your incision
- Fever. It’s common to have a fever right after surgery. Your doctor will give you instructions about when to call for a fever.
- In ability to urinate or move your bowels
- Leg pain, redness or swelling, which could mean you have a blood clot
- Sudden weight gain, which can be a serious sign that you are retaining fluids
- Unexpected bleeding
How might mitral valve surgery affect my everyday life?
Mitral valve surgery may relieve your symptoms and improve your heart function. However, surgery won’t prevent heart disease problems in the future. There are steps you can take to prevent or delay recurrence of heart disease including:
- Eating a heart-healthy diet
- Getting regular exercise
- Maintaining a healthy weight
- Practicing stress management techniques
- Quitting smoking