Mitral valve replacement / Mitral valve repair – Everything you need to know

Mitral valve repair, also commonly known as Mitral valve replacement, is a surgical procedure that is performed to fix or replace a leaky or stiff mitral valve in the heart. The mitral valve is located between the left atrium and left ventricle, both located in the left heart chamber. 

Overview

Depending on the extent of damage on the mitral valve, this procedure can be done either as open-heart surgery or as a minimally invasive heart surgical procedure. Mitral valve problems can manifest itself in two ways:

1. Mitral valve leak (regurgitation) – This particular condition occurs when the mitral valve does not close completely, resulting in blood flowing backwards. 
2. Mitral valve stenosis – This particular condition occurs the mitral valve narrows down in size, resulting in an obstructed blood flow out of the heart’s chambers, and forcing the heart to pump with increased intensity to ensure blood flows through the stiff mitral valve.

When is this procedure performed?

To effectively treat a faulty mitral valve, there are two options – Fix the mitral valve, or replace it. 

When is mitral valve repair recommended?

Based on the Mitral valve repair is recommended for patients who experience the following:

• Holes in the mitral valve
• Malfunctioning valve leaflets
• Presence of excess tissues in the mitral valve
• Changes in the structure of the mitral valve

When is mitral valve replacement recommended?

If the surgeon diagnoses heavy damage to the mitral valve, then the patient is recommended to undergo a mitral valve replacement procedure. Surgeons may either use a mechanical valve or a valve made out of another human heart tissue as a replacement valve. 

Also Read About: Transcatheter Aortic Valve Replacement

How is the surgery performed?

Both mitral valve repair and replacement procedures are performed either through open-heart surgery or through minimally invasive surgery. Depending on the extent of the damage seen in the mitral valve, the surgeon will also have to decide on repairing the valve or completing replacing it. 

What are the risks associated with Mitral Valve Replacement?

The risk of mitral valve procedures involves the following:

• Development of blood clots
• Irregular heart rhythm
• Development of infections
• Minor possibility of stroke

What is the preparation involved for mitral valve procedures? 

To properly prepare for a mitral valve surgery, patients are advised to follow guidelines mentioned below:

• Food and medications – The surgery team will assess the effect of existing medications on the surgery. Along with assessing medications, the surgery team will also check the diet followed by the patient, and will also suggest when to start fasting for the surgery. 
• Clothing and personal items – To prepare for the surgery, patients are advised to bring loose fitting clothes and personal care items like hair brush, toothbrush, shaving items, etc. 
• Precautions regarding medications and allergies – This particular step is important as existing medication can cause allergic reactions or other complications during the procedure. 

What to expect?

Before the surgery

Before the start of the procedure, patients will be given general anaesthesia to put them into a deep sleep, and they will be connected to a heart-lung bypass machine that helps keep the blood flowing normally during the procedure.

During the procedure

The type of mitral valve surgery that needs to be administered is determined well before the surgery date. 

1. Minimally invasive heart surgery

Minimally invasive heart surgery involves the surgeon accessing the heart through small incisions in the chest by navigating through an artery connected to the mitral valve. With the help of a catheter or other specialized surgical instruments, surgeons will repair or replace the faulty valve.

2. Open-heart surgery

Off-pump Heart Bypass Surgery, also known as the Beating Heart Bypass Surgery, is a procedure in which the surgeon opens up the chest cavity of the patient to access the heart, and operates on the mitral valve while the heart is beating. For this procedure, the surgeon will use certain surgical instruments to fix or replace the faulty mitral valve. 

3. Robotic heart surgery

As the name suggests, robotic heart surgery involves the usage of a robotic arm to make a surgical incision, and operate without opening up the chest cavity, and with the use of smaller incisions. The surgeon would control this robotic arm from a console located just outside the surgical room.

4. Transcatheter procedure

This type of procedure involves the insertion of a catheter into a vein and navigating it towards the heart. Using the catheter, surgeon will then proceed to operate or replace the mitral valve. 

After the procedure

Following the procedure, patients will be required to spend 1 to 2 days in ICU for monitoring ay side-effects and how smooth the recovery is. During this time, patients will be given fluids through an IV trip, and other tubes will be attached to drain urine and accumulated fluids from the body. 

Once the patient is deemed fit to be moved to a regular hospital room, the surgical team will begin to monitor the recovery progress, and the patient will also be instructed to perform a few breathing exercises that will help with the recovery. On discharge, the surgeon will advise the patient on when he/she can resume normal activities. 

What are the results of the mitral valve procedure?

Mitral valve repair or replacement procedures have been reported to substantially reduce symptoms and improve the quality of life for patients. If a mechanical vale was used for replacement, patients will be prescribed blood thinners to prevent the development of blood clots. Patients will need to follow this medication throughout their lives. Surgeons will also recommend cardiac rehabilitation programs, and exercise to help with recovery. 

Mitral Valve Replacement and Repair at Apollo Hospitals

At Apollo Hospitals, we have the one of the world’s leading expertise in mitral valve repair and replacement capabilities. With world-class facilities and surgical tools to diagnose and treat mitral valve leakage, Apollo Hospitals are considered to be pioneers in developing minimally invasive techniques which results in shorter post-operative recovery and safer surgeries. 

Conclusion

Mitral valve leakage is a serious medical condition that can negatively impact an individual’s life, and also lead to fatalities. With advancements in minimally invasive surgical techniques, patients now have the option to treat or replace a faulty mitral valve with less risk and complications. Once the surgery is completed, patients may experience a recurrence of symptoms if their lifestyle habits are unhealthy.  Some of the important lifestyle guidelines to follow here include:

• Follow a healthy balanced lifestyle
• Avoid smoking
• Exercise on a regular basis
• Avoid stress triggers 

Frequently Asked Questions (FAQs)

What is the success rate of mitral valve replacement surgery?

The success rate of mitral valve procedures are high, and this is down to the advancements made in surgical techniques, more specifically, minimally-invasive techniques. 

What is the average age for heart valve replacement?

Patients above the age of 70 are usually recipients of heart valve replacements. 

How long do you live after mitral valve replacement?

According to a recent study, the 5-year survival rate for mitral valve replacement is 64% and the 10-year survival rate is 37%.

Can you lead a normal life after heart valve replacement?

Yes, though patients may require several weeks to fully regain normalcy.

Can you replace a mitral valve without open-heart surgery?

Yes, using minimally invasive techniques like transcatheter procedure.