How Common Are Mitral Valve Repair Procedures
Valve surgery is the second-most common heart surgery in the U.S. Over 100,000 people had valve repair or replacement surgery in 2018. The most commonly repaired valve is the mitral valve.
More and more people are having mitral valve surgery either repair or replacement as time goes on. In 2011, more than 14,000 people had isolated mitral valve surgery . By 2016, that number was nearly 18,000.
Plus, some people have mitral valve repair or replacement along with other heart procedures. These include coronary artery bypass grafting and aortic valve replacement. From 2011 to 2016, about 174,000 people had mitral valve surgery either on its own or with other heart procedures.
What Happens After Heart Valve Replacement
Youll start your hospital stay in an intensive care unit so your healthcare provider can keep a close eye on you. Next, youll move to a regular room. Your hospital stay may last five to seven days.
You can expect to have machines checking your blood pressure and heart rate.
There could be tubes draining fluid from your chest.
You can drink, eat and walk as soon as youre able to after your operation. Take a few steps around your room and then down the hallway with help from your healthcare provider.
After you go home, you may go to a cardiac rehab program to help you get stronger.
Recovering From An Aortic Valve Replacement
You’ll usually need to stay in hospital for about a week after an aortic valve replacement, although it may be 2 to 3 months before you fully recover.
You should take things easy when you first get home, but you can start to gradually return to your normal activities over the next few weeks.
You’ll be given specific advice about any side effects you can expect while you recover and any activities you should avoid.
You won’t usually be able to drive for around 6 weeks and you’ll probably need 6 to 12 weeks off work, depending on your job.
Read more about recovering from an aortic valve replacement.
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When Should I See My Healthcare Provider
Your provider will let you know how often you need to return for follow-ups. Be sure to keep all your follow-up appointments and tell your provider how youre feeling.
As you recover, pay attention to how you feel. Everyone has some discomfort, and your provider will prescribe pain medication. But call your provider if you have signs of complications. These include:
What Is A Tavr Procedure
Transcatheter aortic valve replacement is a minimally invasive procedure to replace the aortic valve in patients with severe aortic stenosis. TAVR is less invasive than open-heart surgery, and the procedure typically takes less than one hour. Your heart team will determine if you should have a mild sedative or general anesthesia.
At the start of the procedure, your doctor will make a small cut in one of three typically used access routes: a small cut in the groin , the neck , or a space between your ribs .
The doctor will guide a thin, flexible tube with the heart valve into your artery and to your diseased valve. Throughout the procedure, your doctor will be viewing images of your heart.
The Medtronic TAVR heart valve will be placed in your diseased valve. Your new valve will work immediately. Your doctor will remove the tube and close the cut.
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How Should I Prepare For Heart Valve Surgery
The heart is the main organ of our body, and any kind of operation on the heart deserves special care. In addition, valves are sensitive and need to be treated or replaced properly without complications.
Although maximum types of surgeries are minimally invasive, your body needs proper care before undergoing the pressure of the surgery. Following are some helpful tips that will help you to prepare for the surgery,
Food: You must take proper advice from your health care team about what to eat. In addition, you will also need to confirm whether you need to stop eating or drinking the night before the surgery.
Medication: As the surgeries are quite critical, therefore, you need to clarify the medicine intake before your surgery. This is because different medicines have different side effects that can harm a heart patient.
Important Things to Carry: The surgeries are time-consuming, and you may need to stay in the hospital for longer, depending on your health condition. Therefore it is recommended to carry clothes, important medicines and relaxing items such as books.
Avoid Certain Things: You need to avoid wearing the below-mentioned things during heart valve surgeries –
With all these, hospitals will also contribute to your preparation for example, they will use a special soap to disinfect your body etc.
Types Of Minimally Invasive Heart Valve Repair
Common types of heart valve repair include minimally invasive aortic surgery and minimally invasive mitral valve surgery. Heart valve repair can be performed in different ways, depending on your specific condition. Your physician will evaluate your valvular disease and assess the amount of damage to determine which procedure will best address your needs. All types of minimally invasive heart valve repair involve a surgeon accessing your heart through small incisions in between your rib bones.
There are two main types of minimally invasive heart-repair surgical procedures:
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Who Needs To Have Mitral Valve Repair
People who have mitral valve disease, particularly if the valve leaks, may need mitral valve repair surgery.
If you have a mild form of the disease, you may not need surgery. Your provider may prescribe medications to manage your symptoms. But your provider will keep a close eye on the situation. Theyll use echocardiogram tests to check your heart at regular intervals. You may need surgery later on to manage valve disease thats getting worse or damaging your heart.
You may need mitral valve repair if:
- You have severe regurgitation .
- The regurgitation causes symptoms.
- Your left ventricle isnt pumping out enough blood to your body .
- Your heart is enlarged.
- You have severe mitral valve stenosis with severe symptoms or a very narrow valve opening. But your provider may try other methods first, like balloon mitral valvotomy.
What To Expect During Heart Valve Surgery
Surgeons generally follow the below-mentioned process during any heart valve surgery,
- You will be asked to remove any jewellery or object from your body to avoid complications.
- You have to remove your clothes and wear an operating gown.
- The surgeon will ask you to clear your bladder before the surgery.
- An IV will be started on your hand.
- The surgeon will check your blood pressure, monitor your heart and collect your blood samples.
- The caregiver team will help you to lie down on the operating table on your back.
- There will be continuous monitoring of your body condition.
- After anaesthesia, a breathing tube will be inserted into your throat.
- Surgeons will also insert a catheter to manage the urinary system.
- The clinical team will disinfect your skin with a special solution.
- The whole process of surgery will be started with making an incision from Adams apple to the above point of the navel.
- Then, doctors divide the breastbone and start the procedure of valve repair by stopping the working of the heart.
- In the procedure, surgeons either fuse the valves or remove the affected valves. In addition, they also reshape the valve according to the requirements.
- For further support, surgeons also may place a pacemaker into your heart.
- After the delicate heart valve operation, the breastbone again gets fixed, and the incision is closed.
- The caregiver team will perform the post-surgical healing methods such as insertion of necessary tubes and dressing.
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What Are The Risks Of Heart Valve Surgeries
Though there are a lot of advanced technologies, heart surgeries always have potential risks. These are listed below,
- Breathing trouble as a post-surgical outcome
- Bleeding during surgery or post-surgery can be fatal for the older people
- Getting pneumonia is another potential risk
- Abnormal heart rhythm or arrhythmias is another risk factor
- In serious cases, a patient may need a pacemaker
- A blood clot that causes a heart attack or lung problems
- Infection may grow around the incision site
- Anaesthetic reaction may occur
- After replacement, valve failure also may occur
However, surgeons are nowadays taking the help of minimally invasive operation techniques that are quite helpful to lower the risk factors during surgeries. Hence, for post-heart valve replacement surgery complications, patients should take care of their health properly.
What Are The Advantages Of Heart Valve Surgery
Heart valve surgery can ease your symptoms, improve your life expectancy and help prevent death.
The potential advantages of heart valve repair vs. valve replacement are:
- Lower risk of infection.
- Less need for lifelong anticoagulant medication.
Valve surgeries, including valve repair and valve replacement, are the most common minimally invasive procedure.
The benefits of minimally invasive surgery include:
- Lower risk of infection.
- Other medical conditions you have.
- How many procedures you have in a single operation.
Your cardiologist and surgeon will talk to you about these risks before your surgery.
If youve had a valve fixed or replaced, you may be at a higher risk of getting infective endocarditis. But this can also happen with a faulty valve that isnt repaired. In certain cases, your healthcare provider may prescribe antibiotics to keep you from getting endocarditis from some types of dental work. You can reduce the risk of endocarditis yourself by taking good care of your teeth.
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What To Expect Before Heart Valve Surgery
According to the importance of the surgeries, the preparation may take weeks or even months. You will need to consult with a cardiologist for the surgery. Hence, the expert clinical services you can expect from the hospital are as follows,
- You will get a thorough explanation of the surgery.
- You may undergo some clinical check-ups to ensure your good health.
- The doctor will ask you to fast for at least 8 hours before surgery.
- You need to sign a bond beforehand to proceed further.
- Pregnant women should notify the surgeon beforehand.
- All sorts of medicine, allergies and other complications should be informed to the doctor.
- You may need a blood test to understand how quickly blood can clot.
- You should stop smoking to increase the chances of your recovery.
Replacing The Aortic Valve
Your surgeon will open up your aorta so that they can see the aortic valve. The damaged valve is removed, and the new one put into place and attached with a fine thread .
The surgeon will start your heart again, using controlled electric shocks, before taking you off the heart-lung machine. Your breastbone will be joined up with wires, and the wound on your chest closed using dissolvable stitches. Tubes are inserted into small holes in your chest to drain away any blood and fluid that builds up.
The operation may be performed using smaller incisions and instruments, but you will still need to go on the heart-lung machine. In the future, it may be possible to perform this operation in a less invasive way, without the need for a heart-lung machine.
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How Is It Done
There are many different types of valve repair surgery. Three of the most common are, traditional heart valve surgery, minimally invasive heart valve surgery and transcatheter valve therapies.
Traditional valve repair: This is an open heart surgery that requires your surgeon to open your breast bone to have direct access to the valves of your heart in order to make the required repairs. You will be placed on the heart lung machine in order to perform the procedure.
Minimally invasive valve repair: Uses smaller incisions to repair your heart’s valves. The benefits of minimally invasive surgery include eliminating the need for sternotomy. A smaller incision is made either between the ribs of the upper left side of the chest or the upper portion of the sternum, which means less blood loss and a quicker recovery. Not everyone is a candidate for minimally invasive valve surgery. Your surgeon will determine if this type of surgery is right for you.
Transcatheter Aortic Valve Replacement : The TAVR procedure allows physicians to replace a diseased aortic valve without open-heart surgery. A catheter is inserted through a large artery in the leg and threaded up to the aortic valve. A valve on the end of the catheter is then inserted into the opening of the valve.
MitraClip: A catheter approach to repairing the mitral valve. A catheter is placed into a vein in the leg and threaded up to the mitral valve and a clip is placed on the mitral leaflet for repair.
When Should You Call For Help
911 anytime you think you may need emergency care. For example, call if:
- You passed out .
- Sudden confusion or trouble understanding simple statements.
- Sudden problems with walking or balance.
- A sudden, severe headache that is different from past headaches.
or seek immediate medical care if:
- You have pain that does not get better after you take pain medicine.
- You have loose stitches, or your incision comes open.
- You are bleeding a lot from the incision.
- You have signs of infection, such as:
- Increased pain, swelling, warmth, or redness.
- Red streaks leading from the incision.
- Pus draining from the incision.
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Types Of Replacement Valves
Mechanical and biologic valves are used to replace faulty valves. Mechanical valves are artificial components that have the same purpose as a natural heart valve. Theyre created from carbon and polyester materials that the human body tolerates well. They can last between 10 and 20 years. However, one of the risks associated with mechanical valves is blood clots. If you receive a mechanical heart valve, youll need to take blood thinners for the rest of your life to reduce your risk of stroke.
Biologic valves, also called bioprosthetic valves, are created from human or animal tissue. There are three types of biologic heart valves:
- An Allograft or homograft is made of tissue taken from a human donors heart.
- A porcine valve is made from pig tissue. This valve can be implanted with or without a frame called a stent.
- A bovine valve is made from cow tissue. It connects to your heart with silicone rubber.
Biologic valves dont increase your risk of developing blood clots. This means you most likely wont need to commit to a lifetime of anti-clotting medication. A bioprosthetic doesnt last as long as a mechanical valve and may require replacement at a future date.
Your doctor will recommend which type of heart valve you get based on:
How Do I Prepare
Your surgery could be scheduled weeks in advance, and it’s a good idea to go into your surgery as healthy as you can. Focus on eating well and getting enough sleep and exercise. Try to keep your stress under control.
Your doctor will need information about your health. They’ll want to know what medications or supplements you take. You should also let them know if you smoke, have any allergies, could be pregnant, or have a pacemaker.
They also may want to do a blood test or other tests to make sure you’re healthy enough for surgery.
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Why Is Mitral Valve Repair Done
Mitral valve repair fixes problems with your valve so you can lower your risk of serious complications down the road.
Your mitral valve is the door that connects your left atrium and left ventricle. These are the two chambers of your heart that hold oxygen-rich blood. Your left atrium receives this blood from your lungs. The blood travels through your mitral valve to enter your left ventricle. Then, your left ventricle pumps it out to the rest of your body through your aorta.
Mitral valve disease makes it harder for your valve to do its job. Over time, this can lead to heart and lung damage. Repair through open-heart surgery can help you avoid or delay such problems.
Identifying The Finer Points Of Aortic Valve
Aortic root replacement has evolved from the classic Bentall procedure that replaces the aorta and the aortic valve with a mechanical valve conduit to full replacement with a bioprosthetic valve both described more than 50 years ago to the more current valve-sparing iteration in which the patients aorta is replaced but their native aortic valve is preserved. It has been more than two decades since the aortic valve-sparing procedures were first developed.
Christopher Lau, MD, Director of Endovascular Surgery in the Department of Cardiothoracic Surgery at NewYork-Presbyterian/Weill Cornell Medical Center and an Associate Professor of Cardiothoracic Surgery at Weill Cornell Medicine, and his colleagues here have been at the forefront of clinical practice and research in aortic valve replacement. In this article, Dr. Lau presents a range of research led by NewYork-Presbyterian and Weill Cornell Medicine faculty that is furthering understanding of these complex procedures, including:
- Aortic Root Replacement with and without Valve Replacements
- Valve-Sparing Root Replacement and Bicuspid Valves
- The Influence of Aneurysm Size
- When Connective Tissue Disease is Involved
- Assessing Aortic Blood Flow Following VSRR
Dr. Christopher Lau
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