Details about surgical mitral valve replacement

When the mitral valve becomes too tight, hardened or calcified, then the condition is called mitral valve stenosis. This particular condition prevents blood from moving forward or when they become too loose, condition called mitral regurgitation in which blood tends to flow backwards to atrium and then back to lungs.

Another condition where mitral valve replacement is done is mitral valve prolapsed. This disease can occur due to infection, calcification, or inherited collagen disease.

A minimally damaged mitral valve can be repaired instead of being replaced, but those which are damaged to the extent of not being in the condition to get repaired are replaced surgically via surgical mitral valve replacement.

Procedure

The patient is given general anaesthesia. A 2 inch to 3 inch long cut is made in the right part of the chest near the sternum and the muscle in this area is divided. This lets the surgeon access the heart.

A small cut is made in the left side of the heart for mitral valve to be replaced. In endoscopic surgery, 1 to 4 small holes are made in the chest and surgery is performed using a camera and special surgical tools. In order to perform mitral valve replacement surgery, the heart needs to be stopped to allow the doctor to perform the valve replacement.

For this, a heart lung machine is required wherein the patient is connected to this device through small cuts in the groin or chest. This ensures the blood to be pumped throughout the body by cardiopulmonary bypass machine. Once the blood is completely diverted, the heart is stopped by injecting a cold solution. The mitral valve is then removed by the surgeon and the new one is stitched into place. The two types of valves used in this surgery are:

Mechanical valve: it is made of materials like carbon or titanium and are long lasting. However, patient needs to take blood thinning drugs for rest of their life.

Biological valve: this valve is made of human or animal tissue, mostly from pig or cow tissues. These valves last for 10 to 12 years, but blood thinner administration is not required throughout life.

Once the procedure is complete, the blood circulating through bypass machine is allowed to re-enter the heart and tubes, for which the machines are removed. Sternum is re-joined and sewn with small wires. Tubes are inserted into chest to drain blood and other fluid and connected to suction device.

Protocol for Mitral valve replacement

Complete medical history of patient should be known to the surgeon prior to the surgery. Patients are required to fast for eight hours before the procedure. Pregnancy should be notified to the doctor. Patient needs to be empty bladder during procedure.

After procedure patient is taken to intensive care unit to be closely monitored for several days. Constant ECG and EKG, blood pressure, breathing rate, oxygen level are monitored. In hospital stay is required for several days usually. Driving by patient is to be avoided till doctor’s instruction.

Physician is to be immediately notified on fever or chills, redness, swelling or bleeding of incision site and increased pain around incision site. Those with biological valve replacement need to take blood thinner for at least 6 weeks to 3 months. Prophylactic antibiotics are required as a preventive measure against infection.

Risks associated with mitral valve replacement

Risk associated with mitral valve replacement generally depends on age, general condition, specific medical condition and heart function. Possible risks with the surgery include

  • Bleeding during and after surgery
  • Blood clots that can lead to stroke, heart attack or lung problems.
  • Infection at incision site
  • Pneumonia and breathing problems
  • Dysrhythmias or arrhythmias.
  • Risk of death from surgery is found to be 3 to 9 percent.
  • There is small chance that new valve may not work so doctor needs to check from time to time if valve is working properly.
  • Atrial fibrillation occurs in almost 99 percent of patient who undergo mitral valve replacement surgery.
  • Some patients may also have kidney failure post-surgery.