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Mitral Valve Surgery

Mitral Stenosis

The mitral valve prevents blood from going backwards to the left atrium and lungs after it has entered the left ventricle. Mitral stenosis refers to narrowing of the mitral valve orifice or opening. The valve orifice is usually about 46 square centimeters. Once it gets below 2 square centimeters problems may occur. Sometimes this can be treated with catheter interventions or surgically repairing the diseased valve but often it requires surgical replacement of the valve. Again there are different options for replacing the mitral valve (please refer to the section Types of valves for replacement). The complications are similar to CABG plus the new valve may leak and the chances of having a stroke are slightly higher.

Mitral Insufficiency (Regurgitation)

The mitral valve prevents blood from going backwards to the left atrium and lungs after it has entered the left ventricle. Mitral insufficiency is the term applied to the condition where blood is allowed to flow backwards from the left ventricle to the left atrium through the mitral valve. If the blood does go backwards instead of exiting the heart via the aortic valve it will wind up in the left atrium and may cause problems with the blood flow through the lungs. This condition may arise due to valve degeneration, ischemic disease (coronary artery blockage), or rheumatic fever. Many times this is mild and does not need intervention or symptoms may be helped with medications. If the regurgitation is bad enough surgery may be required. When surgery is required, the valve may be repaired sometimes or replaced depending on why it is leaking.

For additional information on valve repair, please see the section Mitral Valve Repair. Again there are different options for replacing the mitral valve (please refer to the section Types of valves for replacement). The complications are similar to those of mitral valve replacement in mitral stenosis.

Types of valves for replacement

There are several categories of valves that may be utilized for cardiac valve replacement. These include mechanical, tissue, and cadaveric valves to replace the diseased valve. The most common types of valves are tissue valves and mechanical valves. Tissue valves are made from animal hearts, valves, and pericardial tissue. The advantage of tissue valves are that warfarin (coumadin) is not required long term after there placement. The disadvantage is that they eventually wear out. This time period varies from patient to patient and they tend to last longer in the aortic position than the mitral position. Mechanical valves on the other hand rarely need to be replaced due to detioration. They do require the use of coumadin daily for the entire time they are in place.

Mitral Valve Repair

Mitral valve repair is a surgical technique which requires the use of the heart lung machine to fix the mitral valve instead of replacing the valve. This usually entails placing a ring around the valve which helps firmly support the leaflets and reshape the valve and the structures below the valve. Warfarin (coumadin) which is a blood thinner is usually not required long term after this operation unless the patient has atrial fibrillation (irregular heart beat) or another disease which requires its usage.

Definition

The mitral valve is on the left side of the heart. It allows blood to flow from the left upper chamber into the left lower chamber. When the valve is not working well, it may need to be replaced.

Reasons for Procedure

Healthy heart valves allow blood to flow one way. Diseased valves either leak and cause backflow, or narrow and restrict blood flow. The condition can be life threatening. Sometimes the valve can be repaired. Other times, it must be replaced.

Rheumatic fever , other infections, defects at birth, and wear and tear are the most common causes of mitral valve problems.

Possible Complications

Problems from the procedure are rare, but all procedures have some risk. Your doctor will review potential problems, like:

  • Bleeding
  • Infection
  • Damage to the heart or other organs
  • Reaction to anesthesia

Factors that may increase your risk of complications include:

What to Expect

Prior to Procedure

Your doctor will evaluate your general health, and the condition of your heart and circulation. Some tests may include an ECG , echocardiogram , or cardiac catheterization .

Talk to your doctor about medications, herbs, or supplements you are taking. You may be asked to stop taking some medications up to one week before the procedure

Do not eat or drink anything the night before your procedure.

Anesthesia

General anesthesia is given before surgery. You will be asleep.

Description of the Procedure

An incision will be made along the length of the breast bone. The breast bone will be split lengthwise to expose your heart. You will then be put on a heart-lung machine. This machine takes over the work of your heart so that the doctor can stop your heart.

Your heart will be opened. A substitute valve will be sewn into place. This valve may be mechanical (metal and plastic) such as a St. Jude valve, or it may be made of tissue. Tissue valves most often come from a pig or a cow. Tissue valves may also be supplied by a human donor or even manufactured from your own tissues. When the valve is in place, you will be taken off the heart-lung machine and your heart will be re-started. The incision will be closed.

Newer techniques, including robot-assisted procedures , are being developed. These procedures will be able to do the same surgery with smaller incisions.

Immediately After Procedure

You will be taken to a recovery room. Your blood pressure, pulse, and breathing will be monitored.

How Long Will It Take?

About 2-5 hours

How Much Will It Hurt?

Anesthesia will prevent pain during surgery. Pain and discomfort after the procedure can be managed with medications.

Average Hospital Stay

The usual length of stay is 8-10 days. Your doctor may choose to keep you longer if complications arise.

Postoperative Care

You will probably spend 1-3 days in the intensive care unit (ICU) and several more days in a regular hospital room. During this time, your healthcare team will:

  • Observe you for any complications
  • Stabilize your heart function
  • Instruct you in home care and activities

During your stay, the hospital staff will take steps to reduce your chance of infection such as:

  • Washing their hands
  • Wearing gloves or masks
  • Keeping your incisions covered

There are also steps you can take to reduce your chances of infection such as:

  • Washing your hands often and reminding visitors and healthcare providers to do the same
  • Reminding your healthcare providers to wear gloves or masks
  • Not allowing others to touch your incisions

Once you get home:

  • Take prescription medications such as blood thinners or antibiotics if they are prescribed by your doctor.
  • Antibiotics may be needed before dental procedures and during certain other procedures. This will help prevent a valve infection.
  • You will slowly return to your usual activities over a 4-12 week period. You may also be asked to participate in a cardiac rehabilitation program.

Mechanical valves can last a lifetime. Tissue valves last 7-14 years and then must be replaced. If your valve is repaired and you have no complications, you will likely do well and be able to return to normal activities.

Call Your Doctor

It is important for you to monitor your recovery after you leave the hospital. Alert your doctor to any problems right away. If any of the following occur, call your doctor:

  • Signs of infection, including fever and chills
  • Redness, swelling, increasing pain, excessive bleeding, or any discharge from the incision site
  • Constipation , diarrhea , bloody or tarry-color bowel movements, or stomach pain
  • Weight gain—greater than 2 pounds in 2 days
  • Worsening of ankle swelling
  • Severe headache
  • Nausea or vomiting
  • Cough, shortness of breath, or chest pain
  • Coughing up blood
  • Skin rash, or unusual bruising or bleeding
  • Confusion
  • Lightheadedness when standing
  • Tingling in hands and feet
  • Irregular heartbeat, extremely slow pulse, or fast pulse
  • Redness, swelling, or pain in one or both legs
  • Burning during urination

If you think you have an emergency, call for emergency medical services right away.

References

  • Mitral valve disease. Society of Thoracic Surgeons website. Available at: https://ctsurgerypatients.org/adult-heart-disease/mitral-valve-disease. Accessed September 15, 2017.
  • Mitral valve disease: stenosis and regurgitation. Cleveland Clinic website. Available at: http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/cardiology/mitral-valve-disease. Accessed September 15, 2017.
  • Mitral valve replacement. Encyclopedia of Surgery website. Available at: http://www.surgeryencyclopedia.com/La-Pa/Mitral-Valve-Replacement.html. Accessed September 15, 2017.
  • 6/2/2011 DynaMed Plus Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T905141/Treatment-for-tobacco-use : Mills E, Eyawo O, Lockhart I, Kelly S, Wu P, Ebbert JO. Smoking cessation reduces postoperative complications: a systematic review and meta-analysis. Am J Med. 2011;124(2):144-154.
 
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