Mitral valve repair

Overview

Mitral valve repair is a recommended treatment for individuals with mitral valve disease, involving open-heart surgery to address valve issues. When faced with severe mitral valve disease, open-heart surgery may be suggested for either repair or replacement, with a preference for repair, especially in cases of valve leakage, due to its advantages and reduced risks in preserving the patient’s own valve. However, replacement may be necessary for some individuals. It is crucial to understand the reasons for mitral valve repair surgery and its associated risks, which are being mitigated through technological advancements. Additionally, alternative procedures such as minimally invasive repair and percutaneous interventions may be suitable for certain candidates, depending on factors like age and overall health, which should be discussed with a healthcare provider to determine the most appropriate approach for valve repair.

Types

There are several types of procedures for mitral valve repair, such as:

• Annuloplasty: In every mitral valve repair, an annuloplasty is performed. This involves placing a ring, which can be either flexible or rigid, around the edge of the valve. The purpose of this ring is to enhance the durability of the repair over time.
• Triangular or quadrangular resection: This technique is most commonly used when dealing with issues in the posterior leaflet of the valve. The mitral valve has two flaps, the posterior and anterior leaflets. To address problems in the posterior leaflet, the surgeon removes the damaged portion and then sutures the remaining edges together. Typically, a small triangular cut is made to remove the affected part, but in more extensive cases, a rectangular cut may be necessary to remove more tissue.
• Chordal repair: When there is a problem with the anterior leaflet, chordal repair is employed. This method involves the replacement of certain chordae, which are sturdy fibrous strings supporting the mitral valve. The surgeon removes damaged or excessively stretched chords and replaces them. The replacement chords can be made from a synthetic material or healthy chords from another location can be transposed or transferred to replace the damaged ones. Both options provide excellent long-term results.

Reasons for undergoing the procedure.

Mitral valve disease, especially when the valve is leaking, may require mitral valve repair surgery. If you have a mild form of the disease, your doctor might initially prescribe medications to manage your symptoms. However, they will closely monitor your condition using echocardiogram tests. Surgery may become necessary if your valve disease worsens or starts to harm your heart.

You may need mitral valve repair if:

• You have a severe leaky valve (severe regurgitation).
• The leaky valve is causing symptoms.
• Your heart’s left ventricle isn’t pumping enough blood to your body (left-sided heart failure).
• Your heart has become enlarged.

In some cases of severe mitral valve stenosis with significant symptoms or a very narrow valve opening, your doctor might consider other methods first, such as balloon mitral valvotomy.

Risk

Valve surgery can lead to various complications. These may include:

• Arrhythmias (heart rhythm irregularities).
• Excessive bleeding.
• Heart block (an issue with electrical signals in the heart).
• Heart failure (difficulty pumping blood effectively).
• Infection.
• Stroke (blood flow interruption to the brain).

Before the procedure

In preparation for your surgical procedure, it is imperative to collaborate closely with your healthcare provider and adhere to their recommendations.

• Medication management: Discontinue the use of certain medications, such as blood thinners like aspirin and warfarin, in the weeks leading up to the surgery.
• Smoking cessation: Collaborate with your healthcare provider to quit smoking before the surgery.
• Preoperative hygiene: Employ an antimicrobial soap for a thorough cleansing of your body the evening before the surgery.
• Medication administration: Adhere to the prescribed medication regimen on the day of the surgery.
• Fasting protocol: Abstain from food and liquids after a specific time on the day of the surgery.

During the procedure

During mitral valve repair, your surgeon will take the following steps:

• Anesthesia: You’ll be put to sleep using anesthesia.
• Heart-lung machine: You’ll be connected to a machine that temporarily takes over your heart and lung functions.
• Chest incision: Your surgeon will make an incision in your chest. The size and location of the incision depend on the chosen surgical method, which can be a full sternotomy (down the middle of your chest), a partial sternotomy (smaller chest incision), a right thoracotomy (small incision between two ribs), or a robotic-assisted method (several small incisions between ribs).
• Annuloplasty ring: An annuloplasty ring will be placed around your mitral valve to support and reshape it.
• Valve repair: Additional surgical techniques will be used to repair the mitral valve as needed.
• Evaluation: Your surgeon will check the repair’s success and make any necessary adjustments.
• Bypass machine: You’ll be disconnected from the heart-lung machine, allowing your heart and lungs to resume normal function.
• Echocardiogram: A transesophageal echocardiogram will be performed to confirm the successful repair of the mitral valve.

After the procedure

Following your surgery, you can expect to spend one to two days in the Intensive Care Unit (ICU). Your care team will keep a close eye on you, monitoring vital signs such as pulse and breathing. Subsequently, you will spend several additional days in a hospital room to further your recuperation. During this time, you will also receive information on cardiac rehabilitation, and you will receive guidance on caring for your incision once you return home. On average, patients usually stay in the hospital for approximately a week following valve surgery.

Outcome

Recovery after mitral valve repair surgery varies from person to person. It typically takes 4 to 8 weeks, but some may need more time.

Factors affecting your recovery include:

• Severity of heart disease before surgery: More severe conditions may require a longer recovery.
• General health prior to surgery: Existing health issues can slow down your recovery.
• Surgical method: The type of incision used can influence healing time.

After returning home from the hospital, set achievable goals and gradually resume your routine. Your healthcare provider will guide you on when it’s safe to drive, lift heavy objects, and engage in gentle exercise.

Life expectancy depends on the severity of your mitral valve disease and overall health. Discuss with your provider for a better understanding of its impact.

Follow your provider’s recommended schedule for follow-up appointments and keep them as scheduled. If you experience any discomfort during your recovery, remember that some pain is normal, and your provider can prescribe pain medication to help. However, don’t hesitate to contact your provider if you notice any of the following complications:

• Chills or fever
• Chest pain
• Dizziness or fainting
• Severe headache
• Shortness of breath
• Irregular pulse (too slow or too fast)
• Nausea and vomiting
• Persistent incision pain
• Coughing up blood or yellow/green mucus
• Slurred speech or stroke symptoms
• Signs of infection around your incision (oozing or redness)
• Swelling or pain in your lower leg

If you’re on blood thinners, contact your provider if you:

• Fall
• Experience excessive bleeding (nose, gums, or bruising)

If you’re uncertain about whether a symptom is normal during recovery or a sign of a problem, don’t hesitate to contact your care team. It’s always better to get checked out and ensure your well-being.