Mitral Valve Repair & Replacement

What is the mitral valve?

The mitral valve is the valve that separates the left atrium from the left ventricle. The left atrium receives oxygenated blood from the lungs, passing through the mitral valve to the left ventricle, which then pumps the blood to the rest of the body. The valve has two leaflets and closes when the left ventricle contracts. An abnormal mitral valve may either leak (regurgitation or insufficiency) or be too tight (stenosis).

What causes an abnormal mitral valve?

Mitral valve stenosis is typically caused from rheumatic fever as a child. Mitral regurgitation can be caused by structural valve deterioration over time, ruptured chordae, a ruptured papillary muscle (after a heart attack), a dilated heart or an infection (endocarditis).

What are the symptoms of an abnormal mitral valve?

Symptoms are often related to congestive heart failure or an abnormal heart rhythm known as atrial fibrillation (AFib). These include shortness of breath with exertion or lying flat, chest discomfort, fatigue, palpitations and possible ankle swelling.

How is an abnormal mitral valve diagnosed?

If a patient develops any of the above symptoms or a physician hears a murmur, an echocardiogram is usually performed. The echocardiogram examines all of the heart valves, as well as the size and function of the heart and its chambers.

How is it treated?

Symptoms are often controlled with medications until the valve disease becomes severe, which may affect heart function. Once this occurs, a referral to a heart surgeon usually follows for surgical repair. The goal of surgery is to restore normal heart function, and improve symptoms and quality of life.

How is the operation performed?

Surgery requires the use of the heart–lung machine. It can be performed through a traditional sternotomy, through a minimally invasive incision (thoracotomy or hemisternotomy), or robotically. The goal is to repair the valve, but if it is not repairable, it is replaced with either a tissue valve or a mechanical valve. Your surgeon will discuss the surgical options and the best approach for you.

What types of valves are used if replacement is necessary?

The valve may be replaced with a mechanical valve or a bioprosthesis (tissue valve), depending on the needs of each particular patient. Your surgeon will discuss the pros and cons of the different types of valves and the best operative approach for you.

What should I expect after the surgery?

The procedure takes approximately three to four hours. Then you are taken directly to the intensive care unit (ICU). You will have chest tubes and temporary pacemaker wires, which are typically removed by postoperative day 2 or 3. While in the hospital, your activity is increased slowly each day, and discharge from the hospital usually occurs by postoperative day 4 to 5. Physical therapists, in conjunction with your doctors and nurses, will determine if you will be discharged home with home health assistance or to a rehabilitation facility. You will be given detailed instructions upon discharge concerning diet, medications, incision care, sternal precautions, signs and symptoms of an infection or other potential problems, and activity level. You will follow up with your surgeon three to four weeks after discharge, and typically may resume driving and light work duty (no lifting greater than 10 pounds for two to three months, depending on operative approach). You will then follow up with your cardiologist, who will send you to outpatient cardiac rehab.

What are the risks associated with the procedure?

There is about a 5% (5 out of 100) chance of having a complication, including but not limited to infection, bleeding requiring reoperation, stroke, organ system failure such as lungs requiring prolonged ventilation, kidneys requiring dialysis either temporary or permanent, heart attack around the surgery, heart failure, prolonged ICU course or heart block requiring a permanent pacemaker. Chance of death is about 3-5%. These percentages are based on national averages.