Mitral Valve Repair Surgery
As you may know, the left atrium of the heart receives blood that has been infused with oxygen in the lungs and passes it to the left ventricle, the largest of the heart's four chambers. In between the left atrium and the left ventricle is the mitral valve. Heart valve leaflets, also known as flaps or cusps, open-and-close as the heart beats so that blood is kept flowing along the correct path.
When the valve is damaged, blood may leak back into the atrium or there may be insufficient room for the blood to flow properly into the ventricle.
This heart valve disorder is known as mitral valve regurgitation and may require mitral valve repair surgery. (Other names for this valvular defect are mitral insufficiency and mitral incompetence.)
Is Mitral Valve Repair Surgery Common?
Most of the approximately 99,000 heart valve surgeries perform annually in the United States are to replace or repair either the aortic or mitral valve. Both of these valves are located in the heart's left chambers, which are the hardest working chambers in the heart. If the mitral valve insufficiency is mild, the physician may opt to use medications (ACE inhibitors, beta blockers) to treat the symptoms while monitoring the patient for changes. In the most severe cases, a mitral valve repair or mitral valve replacement are needed.
Different Types Of Mitral Valve Repair Surgery
Advances in surgical techniques now make it possible to repair many damaged valves, especially those resulting from a congenital birth defect. There are several procedures that a surgeon might use to perform a mitral valve repair.
- If the valve has narrowed (mitral valve stenosis) and the mitral leaflets have thickened or become fused, the surgeon may perform a commissurotomy. With this procedure, the surgeon cuts the points where the cusps meet, thus opening the valve.
- The surgeon may choose a similar technique, called reshaping, wherein a section of the mitral valve flaps are removed and the cusp is then sewn together again.
- Annuloplasty (shown below) is a technique aimed at repairing the fibrous tissue at the base of the heart valve -- the annulus. Sometimes, the annulus becomes enlarged, which enables blood to back up into the atrium. To repair this, sutures are sewn around an annuloplasty ring to make the opening smaller..
- If calcium has built up on the mitral valve cusps, it can be removed by a procedure called a decalcification, which may allow the calcified mitral valve to close as they should.
- The surgeon may also patch tears or holes in the valve leaflets.
- Finally, the surgeon may need to shorten or replace the cords, the papillary muscles and chordae tendineae, that support the valve.
Heart-Lung Machine And Anesthesia Use During Mitral Valve Repair
A heart-lung machine, or cardiac bypass, is necessary for open-heart surgery. This machine keeps oxygenated blood coursing through the body while the heart is stopped for surgery. Open-heart surgery is performed while the patient is asleep, so a general anesthesia will be used. The patient will be connected to a respirator, which will control his or her breathing during surgery.
Minimally Invasive Mitral Valve Repair
Some patients may be able to undergo minimally invasive surgery for mitral valve repair. This technique requires a smaller incision, typically resulting in shorter hospital stays, faster recoveries, and less pain. However, patients who are obese or who have atherosclerosis are normally not candidates for this technique. Also, if your surgery requires treatment of two valves, the minimally invasive approach is not available to you.
In some hospitals, the surgeon can perform robotic surgery, another minimally invasive surgical procedure. The tools of robotic mitral valve repair surgery are a control console, a system of vision, and a cart with robotic arms. Small incisions are made and instruments are placed inside the incisions. The surgeon then uses the control console to make the wrist and hand movements necessary for the surgery. The surgeon's movements, however minute, are translated by a computer.
Percutaneous Mitral Valve Repair
In addition to minimally invasive approaches to mitral valve repair (mini-thoracotomy, port access), new percutaneous devices use catheters to treat mitral regurgitation without causing trauma to the ribs or sternum. For example, the MitraClip by Abbott Laboratories is one such device. While this technology is currently available in Europe, the MitraClip has yet to receive FDA approval in the United States.
Recovering From Mitral Valve Repair
Most patients spend about five days in the hospital following mitral valve surgery. The patient's health before the operation plays a part in the length of time it will take him or her to fully recover. As a rule, patients are advised to avoid driving for six weeks after surgery. Office workers can typically return to their jobs in six to eight weeks. Those with more physically strenuous jobs may need a longer recovery period before they return to work.
Patients are normally advised to stop smoking at least two weeks before valve surgery. Some medications, such as aspirin or anticoagulants, may need to be stopped or the dosage adjusted in the days leading up to surgery. Patients should also monitor their health closely and advise their surgeon if they experience any symptoms of a cold or flu, such as chills, fever, congestion, drainage or coughing.