Mitral valve replacement: procedure, risks, and outlook
Your mitral valve is one of the four main valves in your heart. It helps blood flow through your heart and to the rest of your body.
When this valve isn’t working properly, it puts a strain on your heart. It also makes it harder for your blood to circulate in a healthy way.
Sometimes problems with your mitral valve can be treated with medication or corrected with surgical repairs. These options are less invasive.
However, in severe cases, the valve will need to be replaced entirely. This is called mitral valve replacement surgery.
Problems with your mitral valve are called mitral valve disease. In some people, mitral valve disease is silent and there are no symptoms until the damage is severe. When symptoms do occur, they include shortness of breath, lightheadedness, and a fast heartbeat.
There are two types of mitral valve disease:
- mitral valve stenosis. In this condition, your mitral valve cannot fully open. As a result, less blood flows through the ventricles of the heart.
- mitral regurgitation. This means your mitral valve is losing blood. In this condition, some of the blood that should be flowing through your heart leaks backwards instead of forwards.
Several factors can lead to mitral valve disease. In some cases, the condition is simply a result of normal aging and wear and tear of the mitral valve. Certain health conditions can also cause mitral valve disease, including:
Your medical team will help you prepare for your mitral valve replacement surgery. One of the first steps is to discuss with your doctor what type of valve you will be getting. You and your doctor can decide together which type of valve is best for you. There are two options for a replacement mitral valve:
- biological valves are made from human, cow or pig heart tissue. They don’t last as long as mechanical valves.
- mechanical valves are man-made. They are long-lived but have a higher risk of infection. If you get a mechanical valve, you’ll need to take blood thinners for the rest of your life.
You may also need to do some tests a week or two before your surgery. These tests help your medical team assess your health. Tests can include:
In the days immediately leading up to your surgery, you will be given specific instructions to follow. Your doctor will give you these instructions before your procedure, but general pre-surgery instructions include:
- Pack a bag with important things.
- Stop taking blood-thinning medications before surgery (while not taking oral medications, talk to your doctor about when to stop and if you should have an injection instead).
- Do not eat or drink anything after midnight the night before your surgery.
- Remove nail polish, jewelry, contact lenses, and dentures before undergoing surgery.
Mitral valve replacement is sometimes performed as open-heart surgery, in which a large incision is made through the breastbone. But there are also minimally invasive options.
Open heart surgery
A mitral valve replacement procedure consists of several steps. You will first be given anesthesia that will put you to sleep and ensure that you do not feel any pain during the procedure. Once you are under anesthesia, your surgical team will:
- Make an incision in the middle of your chest
- Separate your sternum to gain access to your heart
- You’ll be hooked up to a heart-lung machine, which acts as your mechanical heart and lungs during the surgery
- Remove your current mitral valve
- Carefully insert your new mitral valve
- Remove heart-lung machine
- rewire your sternum
- Stitch or staple your skin back together
Mitral valve replacement surgery takes several hours. After the operation is complete, you will be transferred to a recovery room. Nurses and other medical staff in the recovery room will monitor you as you come out of anesthesia before being transferred to a general hospital floor.
Minimally invasive options
Transcatheter Mitral Valve Replacement (TMVR) is a way to replace your valve without open-heart surgery. Instead of making a large incision, your surgeon inserts a thin tube into a vein in your groin. The new valve is then fed through the hose to replace the old valve.
As of 2021, nine different TMVR devices have been studied. None have been approved by the FDA to date.
Robot-assisted mitral valve surgery also eliminates the need for a large incision in the chest. Instead, several small incisions are made. Surgeons control the robotic device as it uses small instruments to perform the surgery.
Typically robot-assisted surgery
All surgery comes with risks, and major surgery like mitral valve replacement isn’t right for everyone. Possible risks are:
Certain people are at higher risk for complications from mitral valve replacement surgery. This includes people who:
- have a weakened immune system or get infections frequently
- have one or more chronic diseases
- have another heart condition
- have pulmonary health concerns
- have obesity
- have kidney failure
- have heart failure
- have suffered a stroke
Additionally, people who are older or whose general health is not appropriate for major surgery may benefit more from other treatment options.
You and your doctor can discuss your mitral valve disease, your risk factors, and whether an exchange is the best choice for you. They can help you weigh your options and make a decision.
Mitral valve repair can help people with mitral valve disease improve their quality of life. It can relieve symptoms and make you feel a lot better than you were before the surgery.
After your surgery, you may participate in a program called cardiac rehabilitation. Cardiac rehabilitation programs are designed to help you recover from your surgery and will teach you exercises and other tips to make the most of your new mitral valve.
It’s important to adopt a healthy lifestyle when you have a mitral valve replacement. Your doctor can help you figure out exactly what this means for you, but common components of a healthy lifestyle include:
In addition, you may need to make changes to your medications after mitral valve replacement. For example, if you have had a mechanical valve replacement, you will need to take blood thinners every day.
You’ll probably need to take antibiotics
They are regularly inspected to ensure your replacement valve is working. If you have received a biological valve, it may need to be replaced again.
Mitral valve replacement is not the only option for treating mitral valve disease. In fact, other options are often preferred because they are less invasive and can preserve your original heart valve. Alternatives to mitral valve replacement are:
- medication Blood thinners, antihypertensive drugs, and diuretics can all be prescribed to treat mitral valve disease. These drugs cannot repair your mitral valve, but they can improve how your heart works and improve blood flow.
- miter clip is a minimally invasive procedure that can help you avoid surgery. Doctors can insert a clip through a vein in your leg and then gently guide it up to your arteries and heart. You can then use the clip to fix leaks in your mitral valve.
- mitral repair Surgery is done when your mitral valve isn’t working properly but is still healthy enough to be repaired. Repair surgeries allow surgeons to fix structural problems so your valve works better.
Does Medicare Cover Mitral Valve Replacement?
Medicare may cover open-heart mitral valve replacement if it is medically necessary. Your doctor must send you proof of your mitral valve disease and previous treatment attempts in order for Medicare to be able to reimburse you.
However, non-invasive TVMR is not FDA approved and therefore not covered by Medicare.
What is the recovery time for a mitral valve replacement?
You will likely spend about 5 days in the hospital after mitral valve replacement. After you return home, it will take several weeks to fully recover from your surgery.
You will be tired and sore for the first 2 or 3 weeks after the surgery, but you will feel better every day. You will be prescribed pain medication to help manage your recovery, and your doctor will let you know when it is safe to resume normal activities.
Do I need a pacemaker after mitral valve replacement?
Some people have mitral valve replacement surgery and need a pacemaker at a later date, but this is not common. For most people, mitral valve replacement surgery improves their quality of life and eliminates symptoms, such as heart palpitations, that may be associated with the need for a pacemaker. Talk to your doctor if you think you may need a pacemaker in the future.
Mitral valve replacement surgery is a serious procedure performed to fix problems with your heart’s mitral valve.
Sometimes doctors can fix problems with your mitral valve with less invasive procedures, like medication or inserting a non-surgical clip. If this is not possible, replacement surgery is an option that can improve your quality of life.
Participating in a post-operative cardiac rehabilitation program can provide you with the training and tools you need to make the most of your replacement heart valve.