Mitral Valve Repair or Replacement

The mitral valve is one of the heart’s four valves, located between the left atrium and left ventricle. Mitral valve disease can involve either narrowing (stenosis) or leakage (regurgitation) of the valve, impairing its function and disrupting blood flow within the heart. Symptoms of mitral valve disease may include shortness of breath, fatigue, palpitations, chest discomfort, and fluid retention. Treatment options for mitral valve disease may include mitral valve repair or replacement, depending on the severity and underlying cause of the condition.

Mitral Valve Repair: Mitral valve repair is a surgical procedure aimed at preserving the patient’s own mitral valve whenever possible. During the procedure, the surgeon may use various techniques to repair the valve, such as:

• Reshaping and reinforcing the valve’s leaflets (flaps)
• Repairing or replacing the chordae tendineae (fibrous cords that support the valve)
• Tightening or reinforcing the annulus (the ring-shaped structure that surrounds the valve)

Mitral valve repair is preferred over replacement whenever feasible, as it preserves the natural anatomy and function of the valve and may offer better long-term outcomes.

Mitral Valve Replacement: Mitral valve replacement involves removing the diseased mitral valve and replacing it with a mechanical valve, tissue valve (bioprosthesis), or a transcatheter valve (transcatheter mitral valve replacement, TMVR). Valve replacement may be necessary in cases where repair is not possible or would not provide adequate valve function. The choice of valve type depends on factors such as the patient’s age, lifestyle, and medical history, as well as the presence of other heart conditions.

Procedure:

1. Preparation: Before the procedure, patients undergo a thorough evaluation, including imaging tests such as echocardiography, to assess the severity and extent of mitral valve disease.
2. Anesthesia: Mitral valve repair or replacement is typically performed under general anesthesia to ensure the patient is asleep and pain-free during the procedure.
3. Surgical Approach: The surgeon makes an incision in the chest, accesses the heart, and exposes the mitral valve. Depending on the planned procedure (repair or replacement), the surgeon performs the necessary repairs or removes the diseased valve.
4. Mitral Valve Repair: If mitral valve repair is feasible, the surgeon performs the necessary techniques to reshape, reinforce, or reconstruct the valve’s components.
5. Mitral Valve Replacement: If mitral valve replacement is necessary, the surgeon removes the diseased valve and sews the replacement valve in place.
6. Closure of Incision: Once the procedure is complete, the incision is closed with sutures or a closure device, and the patient is transferred to the recovery area for monitoring.

Aftercare Following Mitral Valve Repair or Replacement: After undergoing mitral valve repair or replacement, patients require a period of recovery and follow-up care. Here are some key aspects of aftercare:

1. Hospital Stay: The length of hospital stay may vary depending on individual patient factors and the type of procedure performed. Patients typically stay in the hospital for several days following mitral valve repair or replacement to monitor recovery and ensure optimal outcomes.

2. Activity Restrictions: Patients may be advised to avoid strenuous activities and heavy lifting for a period of time following surgery to allow for proper healing. Light activities and gradual return to normal daily routines are usually encouraged under the guidance of healthcare providers.

3. Medications: Patients may be prescribed medications such as antibiotics, pain relievers, and blood thinners to prevent infection, manage pain, and reduce the risk of blood clots following surgery. Compliance with medication regimens and regular follow-up appointments with healthcare providers are important for optimal recovery.

4. Lifestyle Modifications: Adopting heart-healthy lifestyle habits such as maintaining a balanced diet, engaging in regular physical activity, quitting smoking, limiting alcohol intake, and managing stress can help improve overall cardiovascular health and reduce the risk of future heart valve problems.

5. Follow-up Visits: Scheduled follow-up visits with a cardiologist or cardiac surgeon are essential to monitor healing, assess valve function, and address any concerns or complications that may arise. These visits may include echocardiograms or other diagnostic tests to evaluate the effectiveness of the procedure and detect any signs of valve dysfunction or complications.