Mitral valve surgery is surgery to either repair or replace the mitral valve in your heart.
Blood that comes from the lungs enters the left atrium of the heart and crosses into the left ventricle. The mitral valve between these two chambers makes sure that the blood keeps moving forward. When the mitral valve is hardened (calcified), it prevents the blood from moving forward. When the mitral valve is too loose, the blood tends to flow backwards. Both of these conditions cause symptoms and may require mitral valve surgery.
Minimally invasive mitral valve surgery is done through much smaller surgical cuts than the large cuts needed for open surgery.
See also: Mitral valve surgery - open
Mitral valve repair - right mini-thoracotomy; Mitral valve repair - partial upper sternotomy; Robotically-assisted, endoscopic valve repair, Percutaneous mitral valvuloplasty
Before your surgery you will receive general anesthesia. This will make you unconscious and unable to feel pain.
There are several different ways to perform minimally invasive mitral valve surgery.
You may or may not need to be on a heart-lung machine for these types of surgery, but if not, your heart rate will be slowed by medicine or a mechanical device.
If your surgeon can repair your mitral valve, you may have:
If your mitral valve is too damaged, you will need a new valve. This is called replacement surgery. Your surgeon will remove your mitral valve and sew a new one into place. There are two main types of new valves:
The surgery may take 2 -4 hours.
This surgery can also be done through a groin artery, with no cuts on your chest. The doctor sends a catheter (flexible tube) with a balloon attached on the end. The balloon stretches the opening of the valve. This procedure is called percutaneous valvuloplasty.
You may need surgery if your mitral valve does not work properly because:
Minimally invasive surgery may be done for these reasons:
A minimally invasive procedure has many benefits. There is less pain, blood loss, and risk of infection. You will also recover faster than you would from open heart surgery.
Percutaneous valvoplasty is a procedure that is only done in people who are too sick to have anesthesia. The results of this procedure are not long lasting.
Risks for any surgery are:
Minimally invasive surgery techniques have far fewer risks than open surgery. Possible risks from minimally invasive valve surgery are:
Always tell your doctor or nurse:
You may be able to store blood in the blood bank for transfusions during and after your surgery. Ask your surgeon about how you and your family members can donate blood.
For the 2-week period before surgery, you may be asked to stop taking drugs that make it harder for your blood to clot. These might cause increased bleeding during the surgery.
Prepare your house for when you get home from the hospital.
The day before your surgery. Shower and shampoo well. You may be asked to wash your whole body below your neck with a special soap. Scrub your chest two or three times with this soap. You also may be asked to take an antibiotic to guard against infection.
During the days before your surgery:
On the day of the surgery:
Expect to spend 3 - 5 days in the hospital after surgery. You will wake up in the intensive care unit (ICU) and recover there for 1 or 2 days. Nurses will closely watch monitors that show information about your vital signs (pulse, temperature, and breathing).
Two to three tubes will be in your chest to drain fluid from around your heart. They are usually removed 1 - 3 days after surgery. You may have a catheter (flexible tube) in your bladder to drain urine. You may also have intravenous (IV, in a vein) lines to get fluids.
You will go from the ICU to a regular hospital room. Your nurses and doctors will continue to monitor your heart and vital signs until you are stable enough to go home. You will receive pain medicine for pain in your chest.
Your nurse will help you slowly resume some activity. You may begin a program to make your heart and body stronger.
A temporary pacemaker may be placed in your heart if your heart rate becomes too slow after surgery.
Mechanical heart valves do not fail often. However, blood clots can develop on them. If a blood clot forms, you may have a stroke. Bleeding can occur, but this is rare.
Biological valves tend to fail over time, but they have a lower risk of blood clots.
The results of mitral valve repair are excellent. To get the best treatment, go to a center that regularly performs this type of surgery.
Techniques for minimally invasive heart valve surgery have improved greatly over the past 10 years. These techniques are safe for most patients, and they reduce recovery time and pain.
Fullerton DA, Harken AH. Acquired heart disease: valvular. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2008:chap 62.
Popma JJ, Baim DS, Resnic FS. Percutaneous coronary and valvular intervention. In: Libby P, Bonow RO, Mann DL, Zipes DP, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 8th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 55.
Otto CM, Bonow RO. Valvular heart disease. In: Libby P, Bonow RO, Mann DL, Zipes DP, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 8th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 62.
Verma S, Mesana TG. Mitral-valve repair for mitral-valve prolapse. N Engl J Med. 2009; 361: 2261-2269.
Brinkman WT, Mack MJ. Transcatheter cardiac valve interventions. Surg Clin North Am. 2009;89:951-966.
Chandrashekhar Y, Westaby S, Narula J. Mitral stenosis. Lancet. 2009;374:1271-1283. Epub 2009 Sep 9.
Enriquez-Sarano M, Akins CW, Vahanian A. Mitral regurgitation. Lancet. 2009;373:1382-1394.