Mitral valve prolapse is a condition where one or both of the flaps on the heart valve do not close tightly. The mitral valve controls the blood flow through the chambers on the left side of the heart. Surgery is done when traditional medications have failed and blood is flowing backwards into the atrium causing the patient to be very symptomatic.
The primary goal of this surgery is to improve the patient’s symptoms by improving heart function and to reduce the risk of heart failure. Choosing the correct timing for this surgery is important. If the surgery is done before it is necessary the patient is placed at great surgical risk, and if the surgery is performed too late, heart damage may have already occurred.
Mitral Valve Repair Surgery
A mitral valve repair is always the preferred surgical treatment as it is less invasive and safer. Cardiovascular surgeons can frequently repair the heart by modifying the original valve. The mitral valve has two triangular shaped leaflets that normally close tightly. The type of valve repair depends on the damage to the valve.
Sometimes the leaflets must be reconnected to the heart muscle through the annulus ring, which is a muscular ring around the mitral valve. Other times the repair may be completed by removing any excess valve tissue, so the valve can close tightly. The surgeon can also tighten or replace the annulus ring, which is called an annuloplasty.
The repair procedure can be performed robotically, which is minimally invasive, and it ensures a more rapid recovery. The robotically assisted repair is desirable as the incision is smaller and made in the right side of the chest. There is less heart trauma, which means less pain. The hospital stay is also shorter as is the recovery time.
There are several advantages to preforming a value repair versus a valve replacement.
The advantages include:
- An improved long term survival rate
- Heart function is better preserved
- Lower risks of complications
- Blood thinners are unnecessary
- Less risk of stroke
- Less chance of infection
Mitral Valve Replacement
Some heart valves cannot be repaired and must be replaced. Replacement of the mitral valve involves removing the damaged value and replacing it with one of two types of valves. The decision as to which type of valve is made between the doctor and the patient.
- A biological valve is made from a pig, cow or human heart tissue, which are specially treated to avoid the use of any medication to stop the body from rejecting the valve. The biological value will usually have to be replaced after 10 years, but some of the newer valves are lasting 15 or more years.
- The man-made valve is more durable and typically never needs to be replaced; however, the patient will need to take blood thinners for the remainder of their live to prevent blood clots from forming on the valve as they cause strokes and heart attacks.
There are several ways to approach this surgery. In the majority of cases, the valve replacement is an open heart operation where the cardiovascular surgeon makes a large chest incision to remove the damaged valve and sew the new valve in place.
The surgeon can sometimes use a minimally invasive procedure. A small incision is made near the breastbone, which is just under the right pectoral muscle to replace the valve. A mini incision can also be placed in the breastbone (sternum). Long, thin surgical instruments along with a miniature camera are used for this procedure. The length of time of the operation will always depend on the degree of heart damage.
A newer procedure that is also minimally invasive is the da Vinci Mitral Valve Repair. A few small incisions are made between the ribs. The da Vinci System uses a 3D high-definition visual system and special wristed instruments that have greater dexterity then the human wrist. The surgeon has enhanced vision, dexterity, precision and control of the instruments.
Mitral Valve Surgery – Potential Complications
Complications are more common in patients over 70 years of age, and they depend on the patient’s overall health. Minor reactions include nausea, bruising and bleeding. Patients who have chronic conditions, such as diabetes, hypertension, or coronary artery disease are at higher risk. Infections are a potential complication.
Other potential complications are bleeding at the incision site, abnormal heart rhythms, blood clots, strokes, blood loss and cardiac tamponade, which is a life threatening event that occurs if the pericardium sac around the heart fills with blood. If an emergency occurs following surgery that requires a second surgery, then, the risk of complications or death increases.
Post Surgery Recovery Instructions
If the patient had an open heart procedure for the valve replacement they will be kept in the intensive care unit for 24-48 hours. Hospital discharge should occur within the week if there are no problems. Patients that have minimally invasive procedures have a shorter recovery period.
Patients are given written instructions at discharge. The instructions explain wound care and infection recognition. The incision should be kept clean and dry. As the wound heals use a wash cloth with soap and wash the incision gently. Do not use ointment, lotions or salves. Promote healing by eating a healthy diet.
Patients tend to feel much better fairly soon after the surgery as they no longer have the symptoms from the mitral valve malfunction.
Post-surgery Symptoms of Concern
There are very specific reasons to call the doctor for signs of infection.
They signs include:
- An increase in drainage or oozing from incision
- An increased opening along the incision line
- Abnormal heart rhythm, atrial fibrillation
- Warmth and redness around the incision
- Fever greater than 101
- Fluctuating blood sugar levels greater than normal for diabetics
Statistics for Success Rates of Mitral Valve Procedures
Mitral valve repairs are always chosen over mitral valve replacement if possible. Approximately 44,000 mitral valve repairs are done annually. An eight year study of 58,370 patients found the mortality rate for valve repairs was 1.2 percent.
The number of annual mitral valve replacements in the U.S. is 40,000 with the risk of death at five percent for healthy patients. The risk for older patients with other medical problems increases to 10-20 percent.