Mitral Valve Replacement Surgery

Surgery Overview

Mitral valve replacement is most often done as an open-heart surgery. Minimally invasive types of surgery may be another option. The damaged mitral valve is removed and replaced with a new heart valve. The damaged valve is cut out. Then the new valve is sewn in place. The new valve may be mechanical or made of animal tissue. You and your doctor can decide before surgery which type of valve is best for you.

The mitral valve opens and closes to keep blood flowing in the proper direction through your heart. When the mitral valve does not close properly, it's called mitral valve regurgitation. If the valve is very tight and narrow, it's called mitral valve stenosis. In both of these cases, blood does not flow through the heart the right way.

During valve surgery, you are given general anesthesia. In an open-chest surgery, the doctor will make a cut in the skin over your breastbone (sternum). This cut is called an incision. Then the doctor will cut through your sternum to reach your heart. In a less invasive surgery, your doctor may make a smaller cut between your ribs. Your sternum isn't cut.

The doctor will likely connect you to a heart-lung bypass machine. It adds oxygen to your blood and moves the blood through your body. This machine will allow the doctor to stop your heartbeat while working on your heart.

After replacing your mitral valve, the doctor will restart your heartbeat. Then the doctor may use wire to put your sternum back together. Your incision will be closed with stitches or staples. The wire will stay in your chest. The incision will leave a scar that will fade with time.

You may stay in the hospital for a few days after surgery.

What To Expect

Recovery from heart valve surgery usually involves a few days in an intensive care unit (ICU) of a hospital. Full recovery can take several months. Recovery includes healing of the surgical incision, gradually building physical endurance, and exercising.

You will feel tired and sore for the first few weeks after surgery. You may have some brief, sharp pains on either side of your chest. Your chest, shoulders, and upper back may ache. The incision in your chest may be sore or swollen. These symptoms usually get better after 4 to 6 weeks.

You will probably be able to do many of your usual activities after 4 to 6 weeks. But for at least 6 weeks, you will not be able to lift heavy objects or do activities that strain your chest or upper arm muscles. At first you may notice that you get tired easily and need to rest often. It may take 1 to 2 months to get your energy back.

Even though the surgery replaced your mitral valve, it is still important to eat heart-healthy foods, get regular exercise, stay at a healthy weight, take your medicine, and not smoke. Your doctor may suggest that you attend a cardiac rehab program. In cardiac rehab, a team of health professionals provides education and support to help you recover and prevent problems with your heart. Ask your doctor if rehab is right for you.

Life after surgery

After you have a replacement valve, your heart function and your life will largely return to normal. If you had symptoms before surgery, you should feel better than before you had the surgery. For example, you should no longer have shortness of breath and fatigue. But if your heart was already severely affected before your surgery, you may still have complications of heart disease.

After you recover, you should be able to resume most of your normal activities. But you'll have to continue to monitor your condition. You need to watch out for symptoms of blood clots and infections.

A mechanical or tissue valve may need to be replaced after a period of time. So be sure to see your doctor regularly.

If you have a mechanical heart valve, you are more likely to develop blood clots in your heart. So you will take an anticoagulant medicine for the rest of your life to help prevent clots.

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Why It Is Done

Mitral valve regurgitation

For acute mitral valve regurgitation, surgery is done immediately to replace or repair the valve.

For chronic regurgitation, surgery might be recommended if:^{footnote 1}

• You have symptoms.
• Regurgitation is severe.
• Your heart has pumping problems (low ejection fraction).
• Your left ventricle is larger than normal.

The decision to have surgery also depends on what caused mitral regurgitation. It depends on whether it is caused by:

• A problem with the anatomy of the valve (primary regurgitation).
• Another heart problem (secondary regurgitation).

Mitral valve stenosis

Surgery for mitral valve stenosis might be recommended if:^{footnote 1}

• Symptoms are present.
• Stenosis is severe.
• Balloon valvuloplasty is not an option.

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How Well It Works

After a diseased mitral valve is replaced, the new valve works more like a normal valve and allows blood to flow more normally through the heart. Many people feel better and have a better quality of life after surgery.

The outcome of mitral valve replacement depends on a person's heart health and overall health, including other health conditions.

Risks

The exact risks of mitral valve surgery vary depending on the person's specific condition and general health prior to surgery. Younger, healthy people have a lower risk of problems while older people with other health problems have a higher risk.

In general, the risks include:

• Effects from the surgery itself. These include:
  • Bleeding.
  • Infection.
  • Risks from anesthesia.
  • Heart rhythm problems such as atrial fibrillation.
  • Heart attack.
  • Stroke.
• Blood clots caused by the new valve. Replacement with a mechanical valve requires lifelong treatment with anticoagulant medicine to prevent dangerous blood clots.
• Infection around the replacement valve.
• Failure of the new valve. There is a small chance that the valve will not work. Your doctor will need to check from time to time to make sure that your valve is working.
• The need for another valve replacement surgery. Replacement valves last only for a limited time. Having valve surgery again will depend on what type of valve you have and how long you live after your first surgery.
• Death from the surgery. This risk can be higher or lower depending on many things such as age, heart health, and other medical problems.