What is Mitral Valve Replacement?
Mitral valve replacement is a surgery in which a patient's heart's diseased mitral valve is replaced with a mechanical or tissue (bioprosthetic) valve.
Most common reasons for the change of Mitral valve are:
Mitral valve regurgitation- Mitral valve regurgitation is a condition in which the heart's mitral valve doesn't close tightly, which allows blood to flow backward in the heart.
Mitral valve stenosis- It is a medical condition in which the mitral valve flaps thicken and stiffen, and they may fuse together. As a result, the valve aperture narrows and blood flow from the left atrium to the left ventricle is restricted.
Symptoms of mitral valve disease may not appear for several years in some patients. The following are some of the signs and symptoms of mitral valve disease:
- A stethoscope recording of an abnormal heart sound (heart murmur).
- Shortness of breath, especially after a vigorous workout or when lying down
- Irregular heartbeat
There can be several reasons for mitral valve disease, some which may include birth defect, infection, calcification and inherited collagen disease.
Even if you don't have symptoms, your doctor may recommend mitral valve surgery or replacement to avoid complications and improve outcomes. If you need surgery for another heart problem, your doctor may decide to repair or replace the defective mitral valve as well.
Current mitral valve replacement approaches include open heart surgery and minimally invasive cardiac surgery (MICS).
There are two main types of artificial mitral valve:
- Mechanical valves
- Tissue (bioprosthetic) valves
Advantages of mitral valve repair over replacement include lower surgical mortality, lower rates of stroke and endocarditis (an infection of the heart's inner lining), equivalent or better long‑term durability, and improved long-term survival.
When is Mitral Valve Replacement required?
Whenever possible, mitral valve repair is advised since it preserves your heart valve. Surgical repair of a mitral valve may include patching holes in the valve, reconnecting valve flaps (leaflets), separating fused valve leaflets, replacing the valve's support cords, or removing extra valve tissue so that the leaflets can close firmly. Surgeons frequently use an artificial ring to tighten or reinforce the ring around a valve (annulus).
Surgeons may replace your mitral valve if it cannot be repaired. Your surgeon will remove the damaged valve and replace it with a mechanical valve or a valve manufactured from cow or pig heart tissue during mitral valve replacement (biological tissue valve).
Biological tissue valves deteriorate over time and will need to be replaced. A catheter operation can be used to put a new valve in a biological tissue replacement valve that has failed. To avoid blood clots, people with mechanical valves will need to take blood-thinning drugs for the rest of their lives.
How is Mitral Valve Replacement done?
Valve repair/ replacement surgery is done under general anesthesia and takes about four to five hours. There are different approaches to valve repair/replacement surgery. These are:
Open Heart Surgery: This involves a cut in the chest to access the heart.
Minimally Invasive Heart Surgery: Smaller incisions in the chest are used in this procedure. Compared to open-heart surgery, minimally invasive heart surgery results in a shorter hospital stay, faster recovery, and less pain.
Robot assisted Heart Surgery: A sort of minimally invasive surgery in which the surgeon observes the heart on a video monitor from a remote location. Robotic arms are utilized by the surgeon to conduct the same maneuvers as open-heart operations. As a surgery alternative, robotic mitral valve replacement is becoming more popular.
Transcatheter procedure: A cardiologist performs the transcatheter operation in the catheterization lab. A catheter is inserted into a vein and guided to the heart in this type of treatment. The catheter could be used to send tools to the valve to repair or replace it.
After the incision and separation of the breastbone and ribs, the surgeon opens the heart and traces the faulty valve.
The edges around the valve are slightly sliced to help loosen it from the tendons that connect it to the rest of the heart and then the valve can be removed.
The new valve is then inserted and attached into place. After the surgery is done, the patient is taken off the bypass machine and the chest is closed.
What is the Recovery after Mitral Valve Replacement like?
You'll typically spend a day or more in the intensive care unit (ICU) after having mitral valve repair or replacement surgery. You'll be shifted to a regular hospital room for a few days after leaving the ICU. Depending on your condition and the type of surgery you have, the amount of time you stay in the ICU and hospital can vary.
You will need to stay in the hospital at least overnight after a transcatheter procedure, although you may not need to stay in the ICU. There are no tubes needed to drain fluid or blood from your chest with this method.
Your doctors and nurses will keep an eye on your progress. Your blood pressure, respiration, and heart rate will be monitored often. Your doctor will also work with you to manage any post-surgery pain.
As you heal, you'll be told to gradually increase your activities and undertake breathing exercises. During your stay in the hospital, your nurses will assist you in taking longer and longer walks. You will be able to resume your routine work and activities in about 4 weeks, but rigorous work will have to wait for 8-10 weeks and can be undertaken after the surgeon's advice.
What Results Can I Expect from Mitral Valve Replacement?
Mitral valve repair and replacement surgery can help you live a better life by reducing symptoms and improving your quality of life.
You'll need to see your doctor on a frequent basis to ensure that the new or repaired valve is functioning properly.
To avoid blood clots, you'll need to take blood thinners for the rest of your life if your mitral valve was replaced with a mechanical valve. Biological tissue valves degenerate (break down) over time and must be replaced.
Cardiac rehabilitation, a programme of education and exercise designed to help you improve your health and recuperate after heart surgery, may also be recommended by your doctor. Before and after mitral valve surgery, maintaining a healthy lifestyle is critical to your heart's health. A healthy way of life involves the following:
- Smoking cessation
- Exercise on a regular basis
- Eating a well-balanced diet
- Stress management