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Mitral valve surgery - minimally invasive

Mitral valve repair - right mini-thoracotomy; Mitral valve repair - partial upper or lower sternotomy; Robotically-assisted, endoscopic valve repair, Percutaneous mitral valvuloplasty

Mitral valve surgery is surgery to either repair or replace the mitral valve in your heart.

Blood flows from the lungs and enters a pumping chamber of the heart called the left atrium. The blood then flows into the final pumping chamber of the heart called the left ventricle. The mitral valve is located between these two chambers. It makes sure that the blood keeps moving forward through the heart.

You may need surgery on your mitral valve if:

Minimally invasive mitral valve surgery is done through several small cuts. Another type of operation, open mitral valve surgery requires a larger cut.

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Description

Before your surgery you will receive general anesthesia.

You will be asleep and pain-free.

There are several different ways to perform minimally invasive mitral valve surgery.

You will need a heart-lung machine for these types of surgery. You will be connected to this device through small cuts in the groin or on the chest.

If your surgeon can repair your mitral valve, you may have:

You will need a new valve if there is too much damage to your mitral valve. This is called replacement surgery. Your surgeon may remove some or all of your mitral valve and sew a new one into place. There are two main types of new valves:

The surgery may take 2 to 4 hours.

This surgery can sometimes be done through a groin artery, with no cuts on your chest. The doctor sends a catheter (flexible tube) with a balloon attached on the end. The balloon inflates to stretch the opening of the valve. This procedure is called percutaneous valvuloplasty and done for a blocked mitral valve

A new procedure involves placing a catheter though an artery in the groin and clipping the valve to prevent the valve from leaking.

Why the Procedure Is Performed

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

Minimally invasive surgery may be done for these reasons:

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

Risks

Risks for any surgery are:

Minimally invasive surgery techniques have far fewer risks than open surgery. Possible risks from minimally invasive valve surgery are:

Before the Procedure

Always tell your health care provider:

You may be able to store blood in the blood bank for transfusions during and after your surgery. Ask your provider about how you and your family members can donate blood.

If you smoke, you should stop. Ask your provider for help.

During the days before your surgery:

On the day of the surgery:

After the Procedure

Expect to spend 3 to 5 days in the hospital after surgery. You will wake up in the intensive care unit (ICU) and recover there for 1 or 2 days. Nurses will closely watch monitors that display your vital signs (pulse, temperature, and breathing).

Two to three tubes will be in your chest to drain fluid from around your heart. They are usually removed 1 to 3 days after surgery. You may have a catheter (flexible tube) in your bladder to drain urine. You may also have intravenous (IV) lines to get fluids.

You will go from the ICU to a regular hospital room. Your heart and vital signs will be monitored until you are ready to go home. You will receive pain medicine for pain in your chest.

Your nurse will help start activity slowly. You may begin a program to make your heart and body stronger.

A pacemaker may be placed in your heart if your heart rate becomes too slow after surgery. This may be temporary or you may need a permanent pacemaker before you leave the hospital.

Outlook (Prognosis)

Mechanical heart valves do not fail often. However, blood clots can develop on them. If a blood clot forms, you may have a stroke. Bleeding can occur, but this is rare.

Biological valves have a lower risk of blood clots but tend to fail over a long period of time.

The results of mitral valve repair are excellent. For best results, choose to have surgery at a center that does many of these procedures. Minimally invasive heart valve surgery has improved greatly in recent years. These techniques are safe for most people, and can reduce recovery time and pain.

Related Information

Mitral valve prolapse
Marfan syndrome
Endocarditis
Mitral valve surgery - open
Aspirin and heart disease
Clopidogrel (Plavix)
Heart valve surgery - discharge
Taking warfarin (Coumadin)

References

Brinkman WT, Mack MJ. Transcatheter cardiac valve interventions. Surg Clin North Am. 2009;89:951-66. PMID: 19782846 www.ncbi.nlm.nih.gov/pubmed/19782846.

Chandrashekhar Y, Westaby S, Narula J. Mitral stenosis. Lancet. 2009;374:1271-83. Epub 2009 Sep 9. PMID: 19747723 www.ncbi.nlm.nih.gov/pubmed/19747723.

Enriquez-Sarano M, Akins CW, Vahanian A. Mitral regurgitation. Lancet. 2009;373:1382-94. PMID: 19356795 www.ncbi.nlm.nih.gov/pubmed/19356795.

Fullerton DA, Harken AH. Acquired heart disease: valvular. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 19th ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 61.

Otto CM, Bonow RO. Valvular heart disease. In: Mann DL, Zipes DP, Libby P, Bonow RO, Braunwald E, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 10th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 63.

Verma S, Mesana TG. Mitral-valve repair for mitral-valve prolapse. N Engl J Med. 2009; 361: 2261-9. PMID: 19955526 www.ncbi.nlm.nih.gov/pubmed/19955526.

Webb JG, Carroll JD. Transcatheter therapies for structural heart disease in adults. In: Mann DL, Zipes DP, Libby P, Bonow RO, Braunwald E, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 10th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 56.

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Review Date: 3/8/2015  

Reviewed By: Dale Mueller, MD, Cardiovascular and Thoracic Surgeon, HeartCare Midwest; Chairman Department of Cardiovascular Medicine and Surgery, OSF St. Francis Medical Center; and Clinical Associate Professor of Surgery, University of Illinois, Peoria, IL. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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