Mitral Valve Repair

Mitral valve repair is a surgical procedure to fix a damaged mitral valve in your heart, rather than replacing it. This valve controls blood flow between the upper and lower left chambers of your heart. Repairing the valve helps it close properly, improving blood circulation and reducing symptoms like shortness of breath or fatigue.

What is Mitral Valve Repair?

Mitral valve repair is a surgical procedure designed to fix a faulty mitral valve in the heart, aiming to restore its proper function. This approach is generally preferred over replacement because it often preserves the heart's natural structure and may lead to better long-term outcomes for many patients.

Your heart has four valves that keep blood flowing in the correct direction. The mitral valve is located between the left upper chamber (left atrium) and the left lower chamber (left ventricle). It opens to let blood flow from the left atrium to the left ventricle and then closes tightly to prevent blood from flowing backward. When the mitral valve is damaged, it can either fail to close completely, allowing blood to leak backward (mitral regurgitation), or become stiff and narrow, obstructing blood flow (mitral stenosis). Mitral valve repair involves various techniques to correct these problems. Surgeons might reshape the valve leaflets, remove excess tissue, or tighten the ring around the valve (annulus) to help it close properly. The goal is to make the valve function effectively again, ensuring efficient blood circulation throughout your body. This procedure is performed by a cardiac surgeon, often with the support of a specialized heart care team.

Why it's done

Mitral valve repair is performed to correct problems with the mitral valve that disrupt normal blood flow, most commonly mitral regurgitation (a leaky valve) or, less often, mitral stenosis (a narrowed valve). Fixing these issues can relieve symptoms, prevent further heart damage, and improve your overall quality of life.

The primary reason for mitral valve repair is to treat mitral regurgitation, where the valve does not close tightly, causing blood to leak backward into the left atrium. This leakage forces the heart to work harder, which can lead to symptoms like shortness of breath, fatigue, and swelling. Over time, untreated severe mitral regurgitation can weaken the heart muscle and lead to heart failure. While less common for repair, mitral stenosis occurs when the valve opening narrows, restricting blood flow. This can also cause symptoms and strain the heart. Repair aims to restore the valve's ability to open and close correctly, reducing the strain on your heart and improving blood flow. Your doctor will recommend this procedure if your symptoms are severe, if your heart function is declining, or if tests show significant valve damage, even if you don't have many symptoms yet.

How to prepare

Preparing for mitral valve repair involves several medical tests to assess your heart health and overall fitness for surgery, along with detailed discussions with your healthcare team. You will receive specific instructions on medications, diet, and activities to follow in the days and weeks leading up to your procedure.

Before your mitral valve repair, your healthcare team will conduct a thorough evaluation. This typically includes blood tests, an electrocardiogram (ECG) to check your heart's electrical activity, a chest X-ray to view your heart and lungs, and an echocardiogram (echo) to visualize your heart's structure and function. A cardiac catheterization might also be performed to assess the coronary arteries. Your doctor will review all your current medications, including over-the-counter drugs, supplements, and herbal remedies. You may need to stop certain medications, especially blood thinners, several days before surgery to reduce the risk of bleeding. You will also receive instructions on when to stop eating and drinking before the procedure. It is important to ask any questions you have and follow all pre-operative instructions carefully to ensure the safest possible outcome.

What happens during

During mitral valve repair, you will receive general anesthesia and be connected to a heart-lung machine. The surgeon will access your heart, either through a traditional open-chest incision or a minimally invasive approach, to fix the valve using various techniques like reshaping leaflets or tightening the valve ring.

Mitral valve repair is performed under general anesthesia, meaning you will be asleep and feel no pain. A breathing tube will be placed, and you will be connected to a heart-lung machine (cardiopulmonary bypass). This machine temporarily takes over the functions of your heart and lungs, allowing the surgeon to operate on a still heart. The procedure typically takes several hours. Surgeons can approach the heart in a few ways. In traditional open-heart surgery, a long incision is made down the center of the chest, and the breastbone (sternum) is divided. Minimally invasive approaches involve smaller incisions, sometimes between the ribs, and may use specialized instruments and cameras. Once the heart is accessed, the surgeon will repair the valve. Common repair techniques include annuloplasty (tightening the ring around the valve with a band), resecting or reshaping valve leaflets, or repairing the supporting cords (chordae tendineae) that help the valve close. After the repair, the heart-lung machine is disconnected, and your heart resumes its normal function.

Recovery & timeline

Recovery from mitral valve repair typically involves a few days in the hospital, followed by several weeks or months of healing at home. You will gradually increase your activity level, often with cardiac rehabilitation, to regain strength and stamina. Full recovery can take about 6 to 8 weeks, but individual timelines vary.

Immediately after surgery, you will spend time in the intensive care unit (ICU) for close monitoring. You will have tubes and wires for breathing, drainage, and medication delivery. Once stable, you will move to a regular hospital room. Most people stay in the hospital for about 4 to 7 days after surgery. During this time, nurses will help you with pain management, breathing exercises, and getting out of bed to walk short distances. Once discharged, recovery continues at home. You will need to avoid heavy lifting and strenuous activities for several weeks. Your doctor will provide specific instructions on wound care, medication, and activity restrictions. Many patients participate in cardiac rehabilitation, a supervised exercise and education program, to help them regain strength and improve heart health. While you may feel better within a few weeks, full recovery and return to normal activities can take approximately 6 to 8 weeks, or sometimes longer, depending on the individual and the type of surgery performed.

Risks & side effects

Like any major surgery, mitral valve repair carries potential risks and side effects, though serious complications are uncommon. These can include bleeding, infection, stroke, heart rhythm problems, or issues related to anesthesia. Your medical team will discuss these risks with you and take precautions to minimize them.

While mitral valve repair is generally safe, potential risks and side effects exist. Common risks associated with any open-heart surgery include bleeding, infection at the incision site, and adverse reactions to anesthesia. Some people may experience temporary heart rhythm problems (arrhythmias) after surgery, which often resolve or can be managed with medication. More serious, though less common, complications can include stroke, kidney problems, or heart attack. There is also a small risk that the repaired valve may not function perfectly or may require further intervention in the future. Your surgical team will carefully assess your individual health and discuss these risks in detail before the procedure. They will also take steps to reduce these risks, such as using antibiotics to prevent infection and closely monitoring your vital signs throughout and after surgery.

Success rate

Mitral valve repair generally has a high success rate in restoring proper valve function and improving symptoms, especially when performed by experienced surgeons. The long-term durability of the repair is also favorable, with many patients experiencing good outcomes for many years after the procedure.

Mitral valve repair is often highly successful, particularly for mitral regurgitation. Studies show that a significant majority of patients (often more than 90%) have successful repairs that effectively eliminate or significantly reduce the backward leakage of blood. This success often translates to improved symptoms, better heart function, and an enhanced quality of life. The long-term durability of mitral valve repair is also a key advantage. Many repairs last for 10 to 20 years or even longer, meaning many patients do not need another valve procedure. Factors influencing success include the specific type of valve problem, the patient's overall health, and the surgeon's experience. Your cardiologist will discuss the expected success rate and long-term outlook based on your individual condition.

Frequently asked questions

How long does mitral valve repair surgery take?

Mitral valve repair surgery typically takes several hours to complete. The exact duration can vary depending on the complexity of the valve damage and the specific surgical techniques used by the surgeon.

Will I need to take blood thinners after mitral valve repair?

After mitral valve repair, you usually do not need to take blood thinners long-term, unlike with some valve replacement procedures. Your doctor will advise you on any temporary blood thinners needed immediately after surgery.

What is the difference between mitral valve repair and replacement?

Mitral valve repair fixes your existing valve, preserving its natural structure. Mitral valve replacement involves removing your damaged valve and implanting an artificial one. Repair is generally preferred when possible due to better long-term outcomes.

When can I return to work after mitral valve repair?

The time to return to work after mitral valve repair varies. Many people can return to light work within 6 to 8 weeks, but if your job involves heavy lifting or strenuous activity, it may take longer. Your doctor will provide personalized guidance.

Will I have a large scar from mitral valve repair?

The size and location of your scar depend on the surgical approach. Traditional open-heart surgery results in a scar down the center of the chest. Minimally invasive techniques use smaller incisions, leading to smaller scars, often on the side of the chest.

What kind of follow-up care is needed after mitral valve repair?

After mitral valve repair, you will have regular follow-up appointments with your cardiologist, including echocardiograms, to monitor your heart and the repaired valve. Cardiac rehabilitation is also often recommended to aid recovery and improve heart health.

Sources

• MedlinePlus — Mitral Valve Repair
• Mayo Clinic — Mitral Valve Repair
• Cochrane Library — Mitral Valve Repair