• Mitral Valve Replacement

    Definition

    Mitral valve replacement is done when the mitral valve is not working well. The mitral valve is on the left side of the heart. It allows blood to flow from the left upper chamber (left atrium) into the left lower chamber (left ventricle). When the valve is not working well, it may need to be replaced.

    Reasons for Procedure

    Healthy heart valves permit one-way flow of blood. Diseased valves either leak, causing back flow, or narrow, restricting flow. In either case, the condition can be life-threatening. Sometimes the valve can be repaired. At other times it must be replaced.
    Rheumatic fever , infections, congenital defects (defects at birth), and degenerative disease (wear and tear) are the most common causes of mitral valve problems.

    Possible Complications

    If you are planning to have a mitral valve replacement, your doctor will review a list of possible complications, which may include:
    • Bleeding
    • Infection
    • Damage to the heart or other organs
    • Reaction to anesthesia
    The demands of open heart surgery are severe. The better your general health, the less likely you will experience a complication. Some of the risk factors that must be evaluated before you undergo this procedure include:

    What to Expect

    Prior to Procedure

    Only half to three-quarters of all mitral valves can be fixed. You will be thoroughly evaluated. Your doctor will evaluate both your general health and the condition of your heart and circulation. Expect several heart tests, including an electrocardiogram (EKG) and an echocardiogram (using ultrasound).
    Leading up to your procedure:
      Talk to your doctor about your medicines, herbs, or supplements. You may be asked to stop taking some medicines up to one week before the procedure, like:
      • Aspirin or other anti-inflammatory drugs
      • Blood-thinning medicines, such as clopidogrel (Plavix) or warfarin (Coumadin)
    • Do not eat or drink anything starting the night before your procedure.

    Anesthesia

    You will have a general anesthetic . You will be asleep.

    Description of the Procedure

    An incision will be made the length of your breast bone. The breast bone will be split lengthwise to expose your heart. You will then be put on a heart-lung machine. This machine takes over the work of your heart so that the doctor can stop your heart.
    Your heart will be opened. A substitute valve will be sewn into place. This valve may be mechanical (metal and plastic), such as a St. Jude valve, or made of tissue. Tissue valves most often come from a pig (porcine valve) or a cow (bovine valve). Tissue valves may also be supplied by a human donor or even manufactured from your own tissues. Once the valve is in place, you will be taken off of the heart-lung machine and your heart will be re-started. The incision will be closed.
    Mitral Valve Replacement
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    Copyright © Nucleus Medical Media, Inc.
    Newer techniques, including robot-assisted procedures , are being developed. These procedures will be able to do the same surgery with smaller incisions.

    Immediately After Procedure

    You will be taken to a recovery room. There, you will be monitored for any negative reactions.

    How Long Will It Take?

    About 2-5 hours

    How Much Will It Hurt?

    Anesthesia will block pain during the surgery. Your chest and back will be sore following the surgery. Talk to your doctor about medicine to help manage pain.

    Average Hospital Stay

    The usual length of stay is 8-10 days. Your doctor may choose to keep you longer if complications arise.

    Postoperative Care

    At the Hospital
    You will probably spend 1-3 days in the intensive care unit (ICU) and several more days in a regular hospital room. During this time, your care team will:
    • Observe you for any complications
    • Stabilize your heart function
    • Instruct you in homecare and activities
    At Home
    Be sure to follow your doctor's instructions, which may include:
    • If you have a mechanical valve, you will need to take blood thinners for life. This will help to prevent blood clots. But if you have a tissue valve, you will need to take blood-thinning medicine for six weeks to three months after surgery.
    • You may also need to take antibiotics during dental procedures and during certain other procedures. This will help prevent a valve infection.
    • Ask your doctor about when it is safe to shower, bathe, or soak in water.
    • You will slowly return to your usual activities over a 4-12 week period. You may also be asked to participate in a cardiac rehabilitation program.
    Mechanical valves can last a lifetime. Tissue valves last 7-14 years and then must be replaced. If your valve is repaired and you have no complications, you will likely do well and be able to return to normal activities.

    Call Your Doctor

    After you leave the hospital, contact your doctor if any of the following occurs:
    • Signs of infection, including fever and chills
    • Redness, swelling, increasing pain, excessive bleeding, or any discharge from the incision site
    • Constipation , diarrhea , bloody or tarry-color bowel movements, or stomach pain
    • Weight gain (greater than two pounds in two days)
    • Worsening of ankle swelling
    • Severe headache
    • Nausea and/or vomiting
    • Cough, shortness of breath, or chest pain
    • Coughing up blood
    • Skin rash, or unusual bruising or bleeding
    • Confusion
    • Dizzy or lightheaded when standing
    • Tingling in hands and feet
    • Irregular heartbeat, extremely slow pulse, or fast pulse
    • Redness, swelling, or pain in one or both legs
    • Burning during urination
    In case of an emergency, call for medical help right away.

    RESOURCES

    American Heart Association http://www.americanheart.org/

    The Society of Thoracic Surgeons http://www.sts.org/

    CANADIAN RESOURCES

    Health Canada http://www.hc-sc.gc.ca/

    Heart and Stroke Foundation of Canada http://ww2.heartandstroke.ca/splash/

    References

    The Cardiothoracic Surgery Network website. Available at: http://www.ctsnet.org/sections/clinicalresources/adultcardiac/riley.html . Accessed August 31, 2005.

    Mitral valve disease. Cleveland Clinic website. Available at: http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/cardiology/mitral-valve-disease/ . Accessed August 31, 2005.

    Mitral valve regurgitation. Mayo Clinic website. Available at: http://www.mayoclinic.com/ . Accessed August 31, 2005.

    Society of Thoracic Surgeons website. Available at: http://www.sts.org/doc/4107 . Accessed August 31, 2005.

    6/3/2011 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : Mills E, Eyawo O, Lockhart I, Kelly S, Wu P, Ebbert JO. Smoking cessation reduces postoperative complications: a systematic review and meta-analysis. Am J Med. 2011;124(2):144-154.e8.

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