Mitral Valve Repair or Replacement

The mitral valve is one of four valves that regulate blood flow through the heart. The mitral valve helps blood on the left side of the heart flow in one direction. It then closes to ensure blood only moves forward. In mitral valve disease, the mitral valve may not be not be closing properly, which causes blood to flow to leak backward (regurgitation), or the valve may be narrowed (prolapse).

To address either condition, mitral valve surgery (repair and/or replacement) can be performed. Mitral valve surgery can be performed using the following methods: Non-invasive, minimally invasive, or through open-heart surgery. The type of method chosen will vary according to your particular health condition.

Most commonly, minimally invasive methods are preferred, including robotic surgery and transcatheter mitral valve repair (TMVR). The TMVR procedure repairs the mitral valve without removing the old, damaged valve. Somewhat similar to a stent placed in an artery, the TMVR approach delivers a fully collapsible replacement valve to the valve site through a catheter.

To learn more about our minimally invasive approach (TMVR), please visit our TMVR page.

Do you have a question? Request more information and we will connect you with an RWJBarnabas Health cardiovascular expert.

How to Prepare for the Procedure

Before the procedure, your doctor and treatment team will explain to you what to expect before, during and after the procedure and potential risks of the procedure. Talk to your doctor about:

• All medications, herbal products and dietary supplements you are currently taking and ask for their recommendations about each.
• Diabetes and how to adjust your medicine on the day of the procedure.
• Radiation exposure, especially for those that are pregnant.
• Any allergies to medicines, latex, tape, iodine, and anesthetic agents.
• Any history of bleeding disorders.
• Any implanted device (e.g. pacemaker or ICD).
• Any body piercings on your chest or abdomen.

Other recommendations include:

• Eat a normal meal the evening before the procedure. However, do not eat, drink or chew anything after midnight before your procedure. If you must take medications, only take them with sips of water.
• Leave all jewelry at home.
• Remove all makeup and nail polish.
• Wear comfortable clothing when you come to the hospital.
• If you normally wear dentures, glasses, or hearing devices at home, plan to wear them during the procedure.

What to Expect Before the Procedure

Before the procedure, your doctor may perform a variety of diagnostic tests, these may include:

• Cardiac Catheterization
• Computed Tomography (CT scan)
• Magnetic Resonance Imaging (MRI)
• X-Rays
• Echocardiogram (ECHO)
• Electrocardiogram (EKG/ECG)
• Stress Test

What to Expect During the Procedure

Though minimally-invasive methods are often preferred, sometimes patients require open-heart surgery. This type of procedure usually takes anywhere from 2 to 4 hours, but the preparation and recovery may add several hours. This procedure is usually performed in the cardiothoracic operating room (OR). Check with your doctor about the details of the procedure. In general:

• You will change into a hospital gown.
• A nurse will start the intravenous (IV) line in your arm which will administer medications and fluids during the procedure.
• Prior to starting the procedure, you will receive a local anesthetic. Once you are sedated, your doctor may insert a breathing tube through your throat into your lungs and connect you to a ventilator. This will breathe for you during surgery.
• Your doctor will administer general anesthesia (will make you feel sleepy).
• The procedure begins when your doctor exposes your heart by dividing the breastbone (sternum) in half. Your doctor then spreads both halves to gain access to your heart (open-heart surgery).
• For this type of surgery, your heart must be still. Prior to doing so, your doctor will place tubes into your heart so that blood can be pumped through your body by use of a heart-lung machine. This machine takes over for the heart by replacing the heart’s pumping action and the lungs by adding oxygen to the blood.
• Once the blood has been diverted into the bypass machine for pumping, your doctor will then stop the heart by injecting it with a cold solution.

If Your Valve Is Being Repaired:

• When the heart has been stopped, your doctor will begin to repair your mitral valve. Several repair options include:
  • Tighten or reinforce the ring around the valve (annuloplasty).
  • Inserting tissue to patch holes or tears in the flaps that close off the valve.
  • Separate fused valve cusps (balloon valvuloplasty).
  • Reconnecting valve leaflets.
  • Removing excess valve tissue so that the leaflets can close tightly.

^{Medical Illustration Copyright © 2019 Nucleus Medical Media, All rights reserved.}

If Your Valve Is Being Replaced:

• When the heart has been stopped, your doctor will remove the mitral valve and replaces it with a mechanical valve or a valve made from cow, pig, or human heart tissue.

Once the valve is repaired and/or replaced, the doctor will make sure everything is working properly. Once checked, the doctor will let the blood circulating through the bypass machine back into your heart. If your heart is not restarting after the procedure is complete, a mild electric shock may be used to restart it. Your doctor may also put temporary wires for pacing into your heart. These wires can be attached to a pacemaker, if needed, during the initial recovery period. Once the procedure is complete, the heart-lung machine will be turned off. The tubes will be removed and the sternum will be sewn together with the use of sutures or surgical staples.

What to Expect After the Procedure

After the procedure, you will be taken to the cardiothoracic intensive care unit (CTICU) for further observation for several days. This procedure usually requires a hospital stay of several days or even longer. Other recommendations include:

General Guidelines

• The breathing tube is removed when you wake up from anesthesia.
• Diet is started the day after surgery with liquids, and quickly advanced to solids as tolerated.
• Ambulation is started on the first or second day of surgery.
• Urine catheters and drainage tubes (chest tubes) are removed after 24 to 48 hours.
• If you have pacing wires, your doctor will remove them too.
• Nurses, respiratory therapists, and physical therapists will work with you as you begin physical therapy and breathing exercises.
• Your doctor will give you instructions to follow during your recovery.
• A cardiac rehabilitation program may also be suggested.

Do you have a question? Request more information and we will connect you with an RWJBarnabas Health cardiovascular expert.