Mitral Valve Replacement
A mitral valve replacement is performed for replacing a poorly working mitral valve with an artificial one. The heart has four valves, and the mitral valve is one of them. This organ, which lies between the left atrium and left ventricle, helps the blood to flow, through the heart and out to the body.
Indications of Mitral valve replacement
Several types of mitral valve diseases exist. In mitral valve regurgitation, the flaps of the mitral valve don’t close properly, which can cause blood to leak backward into the left atrium. This commonly occurs due to valve leaflets bulging back, a condition which is known as mitral valve prolapse.
Another condition exists, which is known as mitral valve stenosis, where the leaflets become thick or stiff, which can make them fuse together. This can result in the valve opening getting narrowed, which causes a reduction in the blood flow through the valve.
The doctor will generally try to repair your mitral valve, but when a repair is no longer possible then mitral valve replacement is considered.
This procedure is required if your heart’s mitral valve is not working properly. Surgical repair is possible, though sometimes the valve needs a replacement.
First, your doctors will need to check how serious your condition is and if you are experiencing any symptoms. If your condition is too serious, your doctor might be recommending mitral valve repair or replacement. However, if your condition is mild you might not need any surgery.
Your doctor will next need to discuss with you whether mitral valve repair or mitral valve replacement is the most appropriate for you. Doctors generally recommend mitral valve repair but if they see that it is no longer possible, they will need to perform mitral valve replacement. Doctors might next evaluate which method is best for you: Minimally invasive heart surgery or open-heart surgery.
Before the surgery for having your mitral valve repaired or replaced, your doctor and treatment team will need to explain to you, what exactly you can expect before and after the treatment. He/she will also discuss any potential risks. If you have any questions, it is important to discuss them with the doctor and the treatment team. You will also receive instructions that you will need to follow during your recovery time.
You might need a few tests as recommended by your doctor. This can include Chest X-ray, electrocardiogram, echocardiogram, blood tests, coronary angiogram.
Talk to your doctor regarding when you should take your regular medications, and whether you should take them before the surgery. You might also need to stop eating or drinking the night before the surgery.
You will also need to bring clothing and any personal items such as eyeglasses, hearing aids, toothbrush, comb, etc.
Test done before Mitral Valve Replacement
- Electrocardiogram- Electrodes are placed on chest or the limbs to record heart’s electrical impulses.
- Stress test- In this test an electrocardiogram is taken before and immediately after walking on a treadmill.
- Echocardiogram- This non-invasive test in which sound waves allows the doctor to see the heart without making an incision.
- Chest X-Ray- This helps to see the condition of the heart.
- Cardiac catheterization- It involves the insertion of a thin, flexible tube (catheter) into a blood vessel through groin and is pushed forward to the heart. With the help of this test the doctors can diagnose congenital heart defects, check pumping of heart and function of the heart valves
First, you will be sedated before the surgery, with general anesthesia. Therefore, you will be in deep sleep during the procedure and won’t feel any pain.
The operation generally takes several hours. During the procedure, you will be connected to a heart-lung bypass machine, which will keep your blood moving through your body.
First, an incision is made, down the middle of your chest. The doctor will need to separate your heart, to access your breastbone.
Then the surgeon will remove the current mitral heart valve, after which he/she will replace it with a new one. After this is done successfully, the heart-lung machine will be removed, and your breastbone will be wired back together. Then your team will sew or staple the incision in your skin back together again.
If you receive a mechanical valve, you will require blood-thinning medications for the rest of your life for preventing any blood clots. Doctors will be discussing with you all the risks and benefits of each type of valve. He/she will also be discussing which valve is most appropriate for you, before your procedure.
You will be spending a day or more in the ICU. During this time, you will receive fluids, nutrition and medications through intravenous (IV) lines. Other tubes will be draining your urine from the bladder as well as fluid and blood from your heart and chest. You might also be given oxygen.
Next, you will be moved to a regular hospital room for some days. Depending on your condition and the type of surgery you went through, the time you spend in the ICU and hospital will vary.
Your condition will be monitored by your treatment team. They will watch for any signs of infection in your incision sites. Your team might also need to check your blood pressure, heart rate and breathing. Your treatment team will be working with you to manage any pain that you might experience after the surgery.
Your treatment team might instruct you to walk regularly and increase your activity gradually. They might also recommend breathing exercises as you recover.
Your doctor will also be giving you instructions that you will need to follow during your recovery. You will need to be watching for any sign of infection in your incisions, properly caring for the incisions, taking the required medications and managing pain and any side effects after the surgery.
After mitral valve replacement surgery, within a few days you should be able to return to your daily routines, such as work, exercise or driving. Your doctor will be discussing with you when it is okay for you to resume your activities.
You will need to regularly attend follow-up appointments with your doctor. Several tests might be required to evaluate as well as monitor your condition.
Your doctor will likely recommend you to incorporate healthy lifestyle changes. This can include a healthy balanced diet, physical activity, stress management, and avoiding the use of tobacco.
Recovery & risks
The majority of the people who have an open mitral valve replacement usually end up with a successful outcome. However, there are a few risks. Based on your overall health, your particular risks will vary. Make sure that you talk with your doctor if you have any concerns.
Some of the risks include:
- Blood clots leading to a heart or a stroke
- Heart rhythms getting irregular
- Complications from anesthesia
- Memory loss or problems with concentration
- Continued leaking of the valve
- Damage to your nearby organs
There are a few factors which increase the risk of complications:
- Chronic illness
- Heart conditions
- Lung problems
- Increased age
- Being obese
What is the recovery time for a mitral valve replacement?
It takes 4-8 weeks to recover fully from mitral valve replacement surgery.
What is the survival rate for mitral valve replacement surgery?
The survival rate for mitral valve replacement surgery is about 94% with good surgeons.
How many years does a mitral valve repair last?
The patients are free of operation for at least 10 years after mitral valve replacement surgery.