Mitral Valve Replacement Open Heart Surgery

What Are The Advantages Of Mitral Valve Repair

Mitral valve repair has several advantages over valve replacement. These include:

• Better chances of surviving the surgery and living a longer time afterward.
• Improved lifestyle.
• Better preservation of heart function.
• Lower risk of complications like stroke and endocarditis.
• No need for long-term use of blood thinners .

Your provider will recommend a repair, rather than a replacement, whenever possible. Repair is the better option for nearly everyone with mitral valve regurgitation. And its also better for some people with mitral valve stenosis.

But replacement surgery is a better option in some situations. It doesnt take as long as repair surgery, and its less complex to perform.

Talk with your provider about the option thats better for you.

What Is The Outlook For People Who Have Mitral Valve Repair

Mitral valve repair is a durable solution for treating mitral valve disease. Most people can go at least 10 years without needing another surgery. Almost as many can go 20 years. Most people dont need another mitral valve surgery after a successful repair.

Youll need an echocardiogram each year so your provider can check on your valve function. You may also need antibiotics before certain procedures to prevent endocarditis . Talk with your provider about all measures you need to take in the years following your surgery.

What Can I Expect With Open Heart Surgery For Mitral Valve Repair

This has been recommended for me and I am wondering what I can epect

Interested in more discussions like this? Go to the Heart & Blood Health group.

I wonder also, I have been looking into a mitraclip/watchman. I could use the info. also!

Just was diagnosed with leaky valve, told to try meds first already taking amnirodorone, ditilizem, warfarin and water pill what else?

surgery isn’t terrible in terms of pain, the chest takes around 6 months to be somewhat normal and about a year to feel “normal” deep breaths will fill odd for a about 8 months mostly due to they puncture a fluid sack aroundf the heart that takes a while to heal. a little thing most people wont talk about is sometimes you will get a post surgery depression I had a bout with it as well, just know it is normal. Even robin williams had to battle with it so you know it is very normal thing. chicagonow.com/open-heart/2014/08/robin-williams-death-open-heart-surgery-and-depression/

Meh0001, I’m glad you brought this up. The emotional impact of heart surgery is important to keep in mind and good advice for @egoalteredYou may be interested in this related discussion: Heart Disease: Lets Talk About the Emotional Side

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What Surgical Techniques Are Used For Mitral Valve Repair

Providers use several different techniques for mitral valve repair. Talk with your provider about the techniques you can expect for your surgery.

Annuloplasty

All mitral valve repairs include an annuloplasty. This means your surgeon places a complete or partial ring around the rim of your valve. The ring may be flexible or rigid. An annuloplasty makes your repair last for a long time.

Triangular or quadrangular resection

This is the technique surgeons use most often for posterior leaflet prolapse. Your posterior leaflet and anterior leaflets are the two flaps that make up your valve.

Your surgeon resects the damaged part of your leaflet and then sews the remaining edges together. Usually, surgeons can make a small, triangular cut to remove the damaged part. But if a larger area of your leaflet is diseased, your surgeon may need to make a rectangular cut to remove a bit more tissue.

Chordal repair

Surgeons use this technique to repair anterior leaflet prolapse. It involves replacing some of your chordae , which are the tough, fibrous strings that support your mitral valve. Your surgeon removes the ruptured or elongated chords. Then, they create and attach new chords.

Your surgeon may create new chords out of a tough, synthetic material called Gore-Tex®. Or, your surgeon may take healthy chords from another area and put them in place of the damaged ones. This is called chordal transposition or chordal transfer. Both options provide excellent long-term results.

What Is Mitral Valve Surgery

Mitral valve surgery repairs or replaces the mitral heart valve. Heart valves control blood flow through the four chambers of the heart. The mitral valve sits between the left atriumor upper chamberand the left ventricleor lower chamber.

Another name for the mitral valve is the bicuspid valve because it has two leafletsor flaps. The flaps open to allow blood to flow forward and close tightly to prevent blood from leaking backwards. When the valve becomes diseased or damaged, it cant regulate this flow properly. Mitral valve surgery can correct this problem.

There are two main types of mitral valve surgery:

• Mitral valve repair fixes a diseased or damaged mitral valve. There are several types of valve repair surgeries, depending on the specific valve problem. Doctors may make the valve open wider , fix holes or tears in a valve , tighten valve openings , or separate, remove or reshape valve tissue .

• Mitral valve replacement removes a diseased or damaged mitral valve and replaces it with a new valve. New valves can either be mechanical or biological. Mechanical valves are man-made and consist of materials such as titanium or carbon. Biologicalor tissuevalves can come from humans or animals, either pigs or cows

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What Is The Recovery Like For Mitral Valve Replacement

Recovery from valve repair surgery usually takes four to eight weeks. Some people may need more time.

Several factors impact your recovery. These include:

• The severity of mitral valve disease before your surgery. People who had severe regurgitation or reduced heart function need more time to get their strength back.
• Your general health before your surgery. People who had heart failure or kidney failure face a slower recovery.
• The nature of the surgery. If you had valve replacement along with other procedures, like CABG, your recovery may be slower.

Dont push yourself to recover within a certain time frame. Everyone is different. Let your body rest, and accept help from others as you heal.

Your provider will tell you when its safe for you to:

• Take walks or do other forms of exercise.

Replacing A Leaky Valve:

Aortic regurgitation is another common valve problem that may require valve replacement. Regurgitation means that the valve allows blood to return backward through the valve and into the heart instead of moving it forward and out to the body. Aortic regurgitation can eventually lead to heart failure.

Mitral regurgitation may also require a valve replacement. In this condition, the mitral valve allows oxygenated blood to flow backward into the lungs instead of continuing through the heart as it should. People with this condition may experience shortness of breath, irregular heartbeats and chest pain.

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Minimally Invasive Procedure Increases Options For Mitral Valve Repair

A new clinical trial is testing a catheter-based approach to treating mitral valve regurgitation, providing a faster procedure with a shorter recovery time.

Some heart patients havent yet been able to access the growing trend toward minimally invasive procedures. A new clinical trial, though, makes a form of mitral valve repair an option without an open-heart surgery.

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Matthew Romano, M.D., a cardiac surgeon at Michigan Medicine, is leading the ReChord Trial at the University of Michigan Frankel Cardiovascular Center, the only site in Michigan participating. Previously, such patients would have undergone traditional open-heart surgery using the heart-lung machine and stopping the heart to repair or replace the valve, he says. A catheter-based procedure wasnt an option.

This is a significant advance in treating mitral valve disease in a less invasive way with less pain and faster recovery, Romano says of the clinical trial.

Who Is A Candidate For Minimally Invasive Heart Valve Surgery

Although there are rare cases in which I would recommend traditional surgery, most people are eligible for a minimally invasive surgery.Its common for people to hear that theyre too old, sick, or frail to have heart valve surgery. They may not be physically able to handle a long procedure or recovery period. If they have bad knees or hips and rely on their arms to stabilize themselves, it can be even more difficult to allow the breastbone to heal following traditional heart valve surgery.This is not a problem with the minimally invasive procedure. The surgery is much shorter, which eliminates some potential complications from being under general anesthesia for a long time. And because we dont divide the breastbone, we don’t need to wait for it to heal before my patients return to their normal activities.Minimally invasive surgery also is preferable for patients who need to return to work to pay the bills. Instead of waiting a month or more, they will be back to work much quicker.

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Timing Of Surgical Correction Of Mitral Regurgitation

The timing of mitral surgery translates into a simple categorical answer when the patient is seenthat is, should we advise the patient to have mitral surgery promptly or should we advise follow up with conservative management? This process can be stratified according to aetiology and severity of mitral regurgitation.

Mitral Valve Repair: Is Open Chest Or Robotic Surgery Better

Medical Expert: Arnar Geirsson, MD, Chief of Cardiac Surgery, Yale New Haven Hospital

I just received a very interesting question about the surgical approaches to mitral valve repair. Jane asked me, Hi Adam Is open chest or robotic surgery better for mitral valve repair?

To provide Jane an expert opinion, I connected with Dr. Arnar Geirsson, Chief of Cardiac Surgery at Yale New Haven Hospital. Dr. Geirsson is a mitral valve repair specialist and Yale New Haven Hospital is a recipient of the Mitral Valve Repair Reference Center Award for the past three years.

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What Is It Like To Have Mitral Valve Surgery

A team of specialistscardiologists, cardiac surgeons, anesthesiologists, and otherswill work together to determine the best approach for your situation. You will be given general anesthesia, so you will be asleep throughout the operation.

Your operation will vary depending on the surgeons approach:

Open: This is the most common and gold standard approach, requiring a larger incision and opening the chest bone so the surgeon has direct access to the heart.

Minimally invasive: The surgeon works through an incision that is a few inches long on the right side of your chest, dividing the muscles underneath to reach the heart, sometimes utilizing cameras to assist with the operation.

Robotic: The surgeon makes one 2-inch incision and four half-inch incisions in the chest, and inserts robotic arms and tools along with a camera to provide a real-time picture of the progress.

Transcatheter: The surgeon and cardiologist can use a procedure to repair or replace the valve either through the groin or through a small incision in the chest. This technology is new and evolving, and Yale offers various innovative techniques relevant to the mitral valve.

Heart valve surgery requires use of a cardiopulmonary bypass, also known as a heart-lung machine, to temporarily take over the function of the heart and lungs, diverting blood from the heart so that the surgeon can operate.

Mitral valve surgery typically takes one to four hours.

During The Surgical Heart Valve Replacement Procedure

During the procedure, the surgeon opens your chest to get to your heart and the diseased valve. The procedure varies from patient to patient, lasting a minimum of two hours and often longer. During this time, you are asleep under general anesthesia.

The surgeon will remove any tissue and calcium deposits that are interfering with the normal function of the valve. Your damaged valve may be completely removed. Then, the new valve will be sewn into the space where your own valve used to be. After the surgeon makes sure your valve is working properly, blood flow will be restored to your heart and the incisions will be closed. Your surgery is performed while the function of your heart is taken over by a heart-lung machine called cardiopulmonary bypass or CPB.

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The Mitral Valve Replacement Procedure

A mitral valve replacement operation usually takes between three to five hours in which the patient is under general anesthesia and on the heart-lung machine. During the procedure, the surgeon will remove the diseased mitral valve and replace it with a mechanical heart valve replacement or a bioprosthetic heart valve replacement.

To perform the mitral valve replacement, the surgeon must access and open the heart. There are several different approaches the surgeon can use to replace the mitral valve.

• A median sternotomy in which the sternum is completely broken
• A mini-stenotomy in which part of the sternum is broken
• A thoracotomy in which the surgeon accesses the heart through the ribs

Why The Procedure Is Performed

You may need surgery if your mitral valve does not work properly because:

• You have mitral regurgitation — When a mitral valve does not close all the way and allows blood to leak back into the left atria.
• You have mitral stenosis — When a mitral valve does not open fully and restricts blood flow.
• Your valve has developed an infection .
• You have severe mitral valve prolapse that is not controlled with medicine.

Minimally invasive surgery may be done for these reasons:

• Changes in your mitral valve are causing major heart symptoms, such as shortness of breath, leg swelling, or heart failure.
• Tests show that the changes in your mitral valve are beginning to harm your heart function.
• Damage to your heart valve from infection .

A minimally invasive procedure has many benefits. There is less pain, blood loss, and risk of infection. You will also recover faster than you would from open heart surgery. However, some people may not be able to have this type of procedure.

Percutaneous valvuloplasty can only be done in people who are too sick to have anesthesia. The results of this procedure are not long-lasting.

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Who Performs Mitral Valve Surgery

Cardiac surgeons and interventional cardiologists perform mitral valve surgery. A cardiac surgeon specializes in the surgical treatment of conditions of the heart and its blood vessels. Cardiac surgeons may also be known as heart surgeons, cardiothoracic surgeons, or cardiovascular surgeons. An interventional cardiologist specializes in diagnosing and treating conditions and diseases of the heart and blood vessels. They use nonsurgical, catheter-based procedures and specialized imaging techniques.

What Is The Outlook After Mitral Valve Replacement

Mitral valve repair can help people with mitral valve disease improve their quality of life. It can reduce symptoms and help you feel much better than you did before surgery.

Your surgery might be followed by attending a program called cardiac rehabilitation. Cardiac rehab programs are designed to help you recover from your surgery and will teach you exercises and other tips to make the most of your new mitral valve.

Its important to adopt a healthy lifestyle when you have a replacement mitral valve. Your doctor can help you develop exactly what that means for you, but common parts of a healthy lifestyle include:

• getting enough sleep
• managing your stress levels

Additionally, you might have changes to your medications after a mitral valve replacement. For instance, If you received a mechanical valve replacement, youll need to take blood thinners daily.

Youll likely need to take antibiotics before any dental procedures , including cleanings. These procedures might expose you to an infection that can lead to endocarditis.

Youll have regular checkups to make sure your replacement valve is working. If you received a biological valve, it may eventually need to be replaced again.

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Is Mitral Valve Repair An Open

Treatment to cure mitral valve diseases depends on severity associated with your condition. Doctors often recommend you surgery for the repair and/or replacement of mitral valves. A large number of surgical procedures are available for both repair and replacement of mitral valves, including minimally invasive type of heart surgery and open-heart surgery.

Can Mitral Valves Be Repaired Without Surgery

Advances in technology have meant that there are ways in which the mitral valve can be repaired without having to undergo open-heart surgery. The most well known example of this is the Mitraclip procedure. The Mitraclip procedure is described in detail in this linked article. Currently the Mitraclip is reserved for patients that are considered too high risk for traditional mitral valve repair surgery. When I perform these procedures, a heart team that includes interventional cardiologists, cardiac surgeons, and imaging specialists to decide the best possible option for the patient assesses patients.

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What Is Mitral Valve Disease

The mitral valve lets blood flow from one chamber of the heart to another chamber called the left ventricle and prevents it from flowing backward . Its also referred to as the bicuspid valve because it consists of two tapered flaps, also called leaflets.

There are two main types of mitral valve disease:

• Mitral valve regurgitation, in which the leaflets do not close tightly, allowing blood to leak backward into the left atrium. The most common cause of regurgitation is mitral valve prolapse, in which the flaps bulge back into the left atrium.
• Mitral valve stenosis, in which the mitral valve leaflets become thick or stiff, or even fuse together, resulting in a narrowed valve opening and reduced blood flow.