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Mitral Valve Repair Surgery
Relevant information about Mitral Valve Repair Surgery.
The mitral valve or left atrioventricular valve is a flap valve for the left ventricle, which is the heart’s main pumping chamber. It has two leaflets and it controls the blood flow; when the heart contracts, the valve closes to prevent blood from leaking into the lungs and pushes blood to the body. Together with the tricuspid valve, they form the atrioventricular valves.
As a cardiac surgery, the mitral valve repair is an open heart procedure performed to fix a malfunctioning valve, which can be caused by stenosis (narrowing) or regurgitation (leakage). The mitral valve has different origins: it can be a congenital abnormality, a degenerative condition, a consequence of rheumatic fever or ischemic heart disease. In comparison with the valve replacement surgery, this procedure provides a better preservation of the function of the heart, lower rates of complications, infections and strokes, lifestyle improvement and less need for the use of blood thinners. It is the best and most suitable option for patients with a leaking or narrowed mitral valve.
Symptoms of a leaking mitral valve include fatigue, chest pain, migraines, shortness of breath, palpitations and anxiety. Mitral regurgitation can cause abnormal heart rhythms and heart failure. People who need surgery have serious mitral regurgitation or narrowing that may worsen the heart’s functions.
Frequently, the mitral valve is too damaged and it has to be replaced. Nevertheless, sometimes it can be repaired. A type of mitral valve repair is the mitral commissurotomy that is performed on the valves that suffer from a narrowing condition. Another type of surgery is the balloon valvuloplasty which consists on the implementation of a catheter that has a balloon on the end; this is inflated inside the valve in order to expand it. It is also used to correct a regurgitated valve. Mitral regurgitation can be a result of a cleft mitral valve linked to an atrial septal defect (a hole in the heart). This can be fixed by suturing the clefts. The major part of the mitral valves repairs is done for degenerative conditions, which may be caused by the rupture of the chordal apparatus (they support the valve) or by the weakness of the valve. To know if the mitral valve can be repaired or not, the doctors do an echocardiogram to confirm.
General anesthesia is used for the performance of the valve surgery, which usually takes approximately from three to five hours. During the surgery, the surgeon makes a large incision on the patient’s chest, which is connected to a cardiopulmonary bypass (a heart-lung machine). The mitral valve can be repaired or replaced: this depends on the extent of the damage on the valve. If there is limited harm in areas of the mitral valve, repair is the best option. On the other hand, replacement is more suitable for patients who have a calcified mitral valve annulus or severe damage to the tissue and valve. In order to repair the valve, the doctor can add support to the valve annulus adding tissue around the base; reshape the valve eliminating the excess; or he can perform a chordal transposition.
The risks of the Mitral Valve Repair Surgery are bleeding, venous thrombosis (blood clots), pain, lung problems, allergic reactions, kidney failure, stroke, and infections. Additionally, the risks for anesthesia used in the procedure include breathing problems and reactions caused by medications. The success rate of this procedure is generally high and the mortality rate is extremely low. After the surgery, the patient is placed in the Intensive Care Unit for approximately four days. Long term antibiotics must be taken to prevent infections. Activities must be resumed gradually; however, the doctor will decide the intensity of the activities, and the condition must be monitored through regular visits to the doctor. The recovery process takes, commonly, three to six months and it consists of the healing of the incision and exercising. The patients should not feel pain or shortness of breath anymore after the procedure.
Severe complications from the surgery might lead to a long term stay in the hospital facilities, the need of a second surgery, dialysis (if the patient develops renal failure) or blood transfusion.
The minimally invasive Mitral Valve Repair Surgery is performed through a very small incision (2 to 4 inches, opposite to the 6 to 8 inches done in the traditional one) implementing particular and specialized surgical instruments. The benefit of carrying out this type of surgery include: faster recovery process; reduced risk of infection, pain and blood loss; less scarring and faster resume to activities. A type of minimally invasive surgery is the robotically assisted mitral valve procedure. A specially designed computer console is used by the doctor to control the instruments through thin robotic arms, which are inserted in the right side to the chest through a very small incision (1 to 2 inches). This procedure is done to performed difficult repairs.
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