Mitral Valve Replacement: Minimally Invasive

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What is a minimally invasive mitral valve replacement?

A minimally invasive mitral valve replacement is a procedure to replace a poorly working mitral valve with an artificial valve without the need for open heart surgery. The surgery is called “minimally invasive” because it uses a single small incision and specialized instruments rather than a larger incision for the traditional open repair. This may lead to easier and faster recovery from surgery.

The heart has 4 valves. These valves help blood flow through the heart and out to the body by promoting forward flow and preventing backflow. The mitral valve lies between the two chambers of the heart on the left side. These two chambers are the left atrium and the left ventricle. The valve allows blood to flow from the left atrium to the left ventricle in the heart. An artificial valve may be used to replace your poorly working mitral valve. This will make sure that blood can flow into the left ventricle and then flow out to the body normally, without putting extra stress on the heart.

Why might I need a minimally invasive mitral valve replacement?

If the mitral valve is working poorly, you may need it repaired or replaced. Repair of the mitral valve is often possible. However, sometimes replacement is necessary.

Mitral valve stenosis and mitral valve regurgitation (also known as mitral valve insufficiency) are 2 different types of problems that might need valve replacement.

In mitral valve stenosis, the valve is unable to open fully. This means less blood is able to move from the left atria into the left ventricle.
In mitral valve regurgitation, the valve is leaky. Some blood leaks back into the left atrium instead of moving forward into the left ventricle.

These problems can lead to such symptoms as fatigue, shortness of breath, fluid buildup in the legs (edema), fluid buildup in the lungs (pulmonary edema), and heart palpitations. If these symptoms are severe, and/or the valve is severely damaged, you may need valve repair or replacement.

Both mitral stenosis and mitral regurgitation can result from general aging of the valve. Other causes of mitral valve disease include:

Coronary artery disease
Infection of the heart valves
Heart failure
Rheumatic fever
Congenital heart defect (something you are born with)

What are the risks of a minimally invasive mitral valve replacement?

Most minimally invasive mitral valve replacements are a success. But, there are risks with any procedure. Your particular risks will vary based on your overall health, age, and other factors. Possible risks include:

Infection
Bleeding
Irregular heart rhythms, possibly requiring a permanent pacemaker
Blood clots leading to stroke or heart attack
Complications from anesthesia
Damage to the arteries in the legs
Delirium
Inability to complete the procedure as planned resulting in open heart surgery
Death

Certain factors increase the risk of complications, such as:

Chronic illness
Other heart conditions
Lung problems
Increased age
Being obese
Being a smoker
Infections
Vascular disease

Talk with your healthcare provider about any concerns that you have.

How do I get ready for a minimally invasive mitral valve replacement?

As you plan for the surgery, you and your healthcare provider will decide what kind of valve will work best for you. Your surgeon will replace your valve with a biological valve or a mechanical valve.

Biological valves are made mainly from pig, cow, or human heart tissue. Biological valves may not last as long as mechanical valves. You will need to take blood thinners for a time after surgery, but not for life.
Mechanical valves are man-made. If you have a mechanical valve, you will need to take blood thinners for the rest of your life.

Talk with your healthcare provider about how to prepare for your upcoming surgery. Remember the following:

Avoid eating or drinking anything after midnight or for the time you were told before your surgery.
Try to stop smoking before your operation. Ask your healthcare provider for ways to help.
Ask your provider if need to stop taking certain medicines before your surgery. Tell your healthcare provider if you usually take blood-thinning medicines like warfarin or aspirin. Ask which medicines should be stopped prior to surgery, and when, as well as which medicines should be continued.
Tell your healthcare provider about all medicines (prescription and over-the-counter), vitamins, herbs, and supplements that you are taking.
Tell your healthcare provider if you are sensitive to or are allergic to any medicines, iodine, latex, tape, or anesthetic agents (local and general).
If you are pregnant or think you could be, tell your healthcare provider.

Follow your healthcare provider's instructions about when to come to the hospital before your surgery. Be sure to talk with your healthcare provider and ask any questions you have about the procedure.

You may also need some routine tests before the procedure to assess your health . These may include:

Chest X-ray
Electrocardiogram (ECG)
Blood tests
Echocardiogram
Coronary angiogram to assess blood flow in your heart arteries

A short time before the operation, you will likely get medicines to help you relax. In most cases your surgery will proceed as planned, but sometimes another emergency might delay your operation.

What happens during a minimally invasive mitral valve replacement?

Check with your healthcare provider about the details of your procedure. In general, during your minimally invasive mitral valve replacement:

A healthcare provider will give you anesthesia before the surgery starts. This will cause you to sleep deeply and not feel pain during the operation. Afterwards you won’t remember it.
You will be in the operating room for several hours. Family and friends should stay in the waiting room, so the surgeon can update them. A surgeon makes a small 2 to 4 inch incision in your chest to access the heart. The incision may be through the breastbone, to the right of your breastbone, or between the ribs on your side. The surgeon inserts specialized instruments and a tiny camera through the incision to do the surgery. Some surgeons use robot-controlled arms to perform the surgery. Your healthcare provider will review all of your options with you along with their associated risks and benefits.
During the procedure, you will be attached to a heart-lung machine by inserting cannulas into the artery and vein in your groin. This machine will act as your heart and lungs during the procedure.
A transesophageal echocardiogram (TEE) probe will be inserted into your esophagus to allow the surgeon to look at the function of the valve before and after replacement.
Your surgeon will remove your current mitral valve and replace it with a new one.
Your heart will gradually be allowed to take over the work of circulation. It may need to be shocked into a regular rhythm.
The surgery team will remove the heart-lung machine.
The team will then sew or staple the incision in your skin back together.

What happens after a minimally invasive mitral valve replacement?

In the hospital

You will begin your recovery in the intensive care unit or a recovery room.
When you wake up, you might feel confused at first. You might wake up a couple of hours after the surgery, or a little later.
Most people who have mitral valve replacement notice immediate symptom relief after their surgery.
The team will carefully monitor your vital signs, such as your heart rate. You may be hooked up up to several machines so the nurses can check these more easily.
You may have a tube in your throat to help you breathe. This may be uncomfortable, and you won’t be able to talk. The tube is usually removed within 24 hours.
You may have a chest tube to drain excess fluid from your chest.
Bandages will cover your incision. These can come off within a couple of days.
You will feel some soreness, but you shouldn’t feel severe pain. If you need it, you can ask for pain medicine.
Soon after surgery, you will likely be encouraged to get up and sit in a chair. In a day or two, you should be able to walk with help.
You may perform breathing therapy to help remove fluids that collect in your lungs during surgery.
You will probably be able to drink liquids once the breathing tube is removed, usually the day after surgery. You can have regular foods as soon as you can tolerate them.
You may need to wear elastic stockings or compression devices on your legs to help blood circulate through your leg veins.
You will probably need to stay in the hospital for several days but this may vary from patient to patient.

At home

Arrange to have someone to drive you home from the hospital and help at home for a while.
Keep all follow-up appointments. You will probably have your stitches or staples removed at a follow-up appointment in about 7 to 10 days.
Be aware that you may tire easily after the surgery, but you will gradually start to recover your strength. Recovery time after minimally invasive valve surgery tends to be less than for an open mitral valve replacement.
After you go home, take your temperature and weigh yourself every day. Tell your healthcare provider if your temperature is over 100.4°F (38˚C), or if your weight changes.
Call your healthcare provider if you have shortness of breath or swelling in your legs.
Ask your healthcare provider about when it is safe for you to drive.
Avoid lifting anything heavy for several weeks. Ask your healthcare provider about what is safe for you to lift.
Follow all the instructions your health care provider gives you for medicines, exercise, diet, and wound care.
Tell all of your dentists and other healthcare providers about your health history. You may need to take antibiotics before certain medical and dental procedures to prevent getting an infection on your replacement valve.
Be aware that your healthcare provider may suggest that you begin a cardiac rehabilitation program, which gradually reintroduces you to a normal lifestyle. Cardiac rehabilitation begins in the hospital with simple walking. The program progresses to t a regular exercise routine and a nutritious diet. Committing to healthier habits can prevent future heart problems.