Surgery to repair or replace the mitral valve happens at a hospital. A heart surgeon, called a cardiovascular surgeon, performs the surgery.
If you also need heart surgery for another condition, the surgeon may do both surgeries at the same time.
Before
Before mitral valve surgery starts, a member of your care team may shave any body hair from your chest area. Your care team cleans your skin using a special soap that kills germs and helps prevent infection.
You get medicines to put you in a sleeplike state if you're having open-heart or minimally invasive surgery. This is called general anesthesia. You are connected to a heart-lung bypass machine, which keeps blood moving through the body during the surgery.
During
What happens during mitral valve repair and replacement depends on the specific method used. Doctors can do mitral valve surgery in different ways.
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Open-heart surgery. The surgeon makes a cut, called an incision, through the middle of the chest to reach the heart.
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Minimally invasive heart surgery. The surgeon uses much smaller cuts than in open-heart surgery. This approach may mean a shorter hospital stay, faster recovery and less pain than open-heart surgery. It's generally best to have minimally invasive heart valve surgery done at medical centers with doctors and teams experienced in doing these surgeries often.
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Robot-assisted heart surgery. This is a type of minimally invasive surgery. A surgeon uses robotic arms to make precise movements during surgery.
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Catheter-based procedure. Some heart valve repairs use a long, thin tube called a catheter. Through the catheter, a doctor can pass clips, plugs or other devices to repair or replace the mitral valve. Examples of catheter-based procedures are transcatheter mitral valve replacement (TMVR) and mitral valve clip, also called transcatheter edge-to-edge repair (TEER).
Mitral valve repair
Heart doctors recommend mitral valve repair when possible. During mitral valve repair surgery, a surgeon might:
- Patch holes in the mitral valve.
- Reconnect the valve flaps, called leaflets.
- Remove extra tissue from the valve so that the flaps can close tightly.
- Replace or remove pieces of tissue called cords that are diseased and no longer support the valve.
- Separate valve flaps that are stuck together.
- Tighten or reinforce the ring around the valve, called the annulus.
Types of mitral valve repair include:
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Annuloplasty. Surgeons tighten or reinforce the ring around the valve. Annuloplasty may be done alone or with other methods to repair a heart valve.
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Valvuloplasty. Also called balloon valvotomy, this treatment widens a narrowed mitral valve opening. The doctor inserts a long, thin tube called a catheter with a balloon on the tip into a blood vessel in the arm or groin and guides it to the mitral valve. The balloon is inflated. This makes the mitral valve opening larger. The doctor then deflates the balloon and removes the catheter and balloon.
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Mitral valve clip. A doctor guides a catheter with a clip on its end from a blood vessel in the groin to the mitral valve. The clip is used to fix a torn or leaky mitral valve flap, called a leaflet. Your healthcare team may recommend this treatment if you have severe mitral valve regurgitation and you cannot have other types of mitral valve surgery. Mitral valve clip also is called transcatheter edge-to-edge repair (TEER).
Mitral valve replacement
During mitral valve replacement, the heart surgeon removes the mitral valve and replaces it with a new one. The new valve may be a mechanical valve or a valve made from cow, pig or human heart tissue. This is called a biological tissue valve.
Sometimes, if a biological tissue valve no longer works well, the doctor can place a new valve inside it using a thin, flexible tube called a catheter. This is called a valve-in-valve procedure, also called a transcatheter mitral valve-in-valve procedure.
After
After mitral valve repair or replacement surgery, you usually spend a few days in the hospital. How long you stay in the hospital depends on your specific condition and surgery.
During your hospital stay, your care team often checks your blood pressure, breathing and heart rate. You may get:
- Fluids and medicines through an IV.
- Oxygen.
- Pain medicine.
You might have tubes to drain urine from your bladder and fluid and blood from your chest.
In the hospital, your care team helps you:
- Slowly build up your activity level.
- Take longer and longer walks in the hospital.
- Do breathing exercises.
Your care team gives you instructions to follow during recovery, such as:
- How to care for your surgical cuts, called incisions.
- What medicines to take and when.
- How to manage pain and other side effects.
- Signs of infection and when to call your care team.
After mitral valve repair or mitral valve replacement, your healthcare professional tells you when it's safe to return to daily activities, such as working, driving and exercise.