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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, a ruptured chordae, ruptured papillary muscle (after a heart attack), a dilated heart, or 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. 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 restore normal heart function and to 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 what is 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 particular 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 3-4 hrs and then you are taken directly to the ICU.  You will have chest tubes and temporary pacemaker wires which are typically removed by post operative 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 3-4 weeks after discharge and typically may resume driving and light work duty (no lifting > 10lb x 2-3 mo depending on operative approach).  You will then follow up with your cardiologist who will then 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, heart block requiring a permanent pacemaker, and about a 3-5% chance of death. These percentages are based on national averages.

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