If you have mitral valve disease, you may eventually need mitral valve repair or mitral valve replacement surgery to treat your condition.
Your doctor may often recommend mitral valve repair if possible, as it preserves your mitral valve and may preserve heart function. Having your mitral valve repaired may also help you to avoid complications that can occur with mitral valve replacement, such as the risk of blood clots with mechanical valves and the risk of biological tissue valves failing over time.
During the procedure
You'll receive anesthetics, and you'll be unconscious during the procedure. You'll be connected to a heart-lung bypass machine, which keeps blood moving through your body during the procedure.
Mitral valve surgery generally may be performed with open-heart surgery, which involves a cut (incision) in the chest.
In some cases, mitral valve repair surgery may be performed with minimally invasive heart surgery, in which surgeons perform the procedure through small incisions in the chest.
Minimally invasive heart surgery includes surgery performed using long instruments inserted through one or more small incisions in the chest (thoracoscopic surgery), surgery performed through a small incision in the chest, or surgery performed by a surgeon using robotic arms (robot-assisted heart surgery).
In robot-assisted heart surgery, a surgeon sits at a remote console, viewing the heart in a magnified high-definition 3-D view on a video monitor. The surgeon uses robotic arms to duplicate specific maneuvers used in open-heart surgeries. These procedures may be available at certain medical centers.
Minimally invasive heart surgery may involve a shorter hospital stay, quicker recovery and less pain than open-heart surgery. Minimally invasive heart surgery generally should be performed at medical centers with a medical team experienced in performing these types of procedures.
Mitral valve repair
Mitral valve repair surgery may include patching holes in a valve, reconnecting valve leaflets, removing excess valve tissue so that the leaflets can close tightly, replacing cords that support the valve to repair the structural support, and separating valve leaflets that have fused. Surgeons often may tighten or reinforce the ring around the valve (annulus) in a procedure called an annuloplasty.
Doctors may perform certain mitral valve repair procedures using a long, thin tube (catheter) and clips or other devices.
In one catheter procedure, doctors insert a catheter with a clip attached in an artery in the groin and guide it to the mitral valve. Doctors use the clip to reshape the mitral valve. People who have severe symptoms of mitral valve regurgitation and who aren't candidates for surgery or who have high surgical risk may be considered for this procedure.
Doctors may also use a catheter procedure to insert a device to plug leaks in a leaking replacement mitral valve that previously has been implanted to replace the mitral valve.
A mitral valve with a narrowed opening may also be treated with a catheter procedure called a balloon valvuloplasty. In this procedure, a doctor inserts a catheter with a balloon on the tip into an artery in your arm or groin and guides it to the mitral valve. A doctor then inflates the balloon, which expands the opening of the mitral valve. The balloon is then deflated, and the catheter and balloon are removed.
Mitral valve replacement
If your mitral valve can't be repaired, your doctor may recommend mitral valve replacement. In this procedure, your doctor removes the mitral valve and replaces it with a mechanical valve or a valve made from cow, pig or human heart tissue (biological tissue valve).
Biological tissue valves often eventually need to be replaced, as they degenerate over time. If you have a mechanical valve, you'll need to take blood-thinning medications for the rest of your life to prevent blood clots. Doctors will discuss with you the risks and benefits of each type of valve and discuss which valve may be appropriate for you.
When possible, doctors may preserve the cords supporting the valve during the procedure, in order to preserve as much of the heart's function as possible.
In some cases, a catheter procedure may be conducted to insert a replacement valve in a biological tissue valve in the heart that is no longer working properly.
Some doctors are also studying using catheter procedures to replace a mitral valve that is no longer working properly, and some medical centers may offer this procedure as part of clinical trials for people with severe mitral valve disease who aren't candidates for surgery.
After the procedure
You'll generally spend a day or more in the intensive care unit (ICU). You'll be given fluids, nutrition and medications through intravenous (IV) lines. Other tubes will drain urine from your bladder and drain fluid and blood from your heart and chest. You may be given oxygen.
After the ICU, you'll be moved to a regular hospital room for several days. The time you spend in the ICU and hospital can vary, depending on your condition and the type of surgery you had.
Your treatment team may monitor your condition and watch for signs of infection in your incision sites. Your team may check your blood pressure, breathing and heart rate. Your treatment team will also work with you to manage pain you may experience after surgery.
Your treatment team may instruct you to walk regularly to gradually increase your activity and to do breathing exercises as you recover.
Your doctor may give you instructions to follow during your recovery, such as watching for signs of infection in your incisions, properly caring for incisions, taking medications, and managing pain and other side effects after your surgery.