Key Takeaways of Mitral Valve Replacement Procedure

• Type of Procedure: Open-heart or minimally invasive surgery
• Duration: 3 to 6 hours
• Anesthesia Used: General anesthesia
• Hospital Stay: 5 to 10 days
• Recovery Time: 6 to 12 weeks for routine activities and 6 months for full recovery
• Success Rate: 85 to 95% 5-year survival for elective cases.

Types of Mitral Valve Replacement

Different approaches are used based on patient needs:

Mechanical Valve Replacement

• Here the valve is made of durable carbon or titanium materials.
• Lasts 20 plus years.
• Requires lifelong blood thinners.

Biological Valve Replacement

• Sourced from animal tissue (pig/cow).
• Lasts 10 to 15 years.
• No long-term blood thinners needed.

Surgical Approaches

• Median Sternotomy: This is the traditional open-heart surgery approach, where the surgeon makes a vertical incision down the center of the chest and splits the breastbone to access the heart directly. It provides a full view of the heart and is used in complex cases.
• Minimally Invasive: This method involves a smaller incision on the right side of the chest, between the ribs. It avoids cutting through the breastbone, resulting in less pain, a smaller scar and faster recovery.
• Robotic-Assisted: The surgeon operates through tiny incisions with enhanced precision and control using robotic instruments. This is used in select cases where advanced technology is available. The robot is guided by the surgeon at a console, allowing for highly accurate movements and minimal trauma to surrounding tissues.

Indications for Mitral Valve Replacement

Indications for mitral valve replacement surgery include:

• Severe Symptoms: Shortness of breath, fatigue, chest pain or dizziness caused by the malfunctioning valve.
• Heart Failure: When the valve contributes to heart failure and impairs the heart's ability to pump blood effectively.
• Valve Stenosis: Severe narrowing of the mitral valve leading to restricted blood flow.
• Valve Regurgitation: Leakage of the valve, allowing blood to flow back into the left atrium.
• Structural Damage: Congenital disabilities, infections or other issues affecting the valve.
• Decreased Heart Function: When the heart's pumping ability is compromised.
• Failed Repair: Prior attempts to repair the valve didn't work.
• Chronic Atrial Fibrillation: Associated with mitral valve dysfunction.
• Deterioration of Biological Valves: In patients with a prior biological valve that has deteriorated over time.

Who is a Candidate for Mitral Valve Replacement?

Ideal candidates include:

• Patients with severe valve dysfunction and symptoms.
• Asymptomatic patients with heart enlargement or pulmonary hypertension.
• Those medically fit for major surgery.
• Cases where valve repair is not possible.

Preparation for Mitral Valve Replacement Surgery

Preparing for mitral valve replacement surgery involves a combination of medical, logistical and emotional steps to ensure a smooth and successful procedure. Here's a guide on how to prepare:

• Consultation: Meet with your cardiothoracic surgeon to discuss the procedure, understand its necessity, and address any questions or concerns you may have.
• Medical Assessment: Undergo a comprehensive medical assessment, which may include blood tests, imaging scans, and electrocardiograms (ECG), to evaluate your overall health and heart condition.
• Medications: Inform your medical team about all medications, supplements, and herbs you're taking. Some medications might need to be adjusted or temporarily stopped before surgery.
• Lifestyle Changes: Follow any recommended lifestyle changes, such as quitting smoking, improving your diet, and managing chronic conditions like diabetes or high blood pressure.
• Preoperative Instructions: Adhere to any preoperative instructions provided by your surgical team, such as fasting before the surgery or using specific antiseptic soaps for hygiene.
• Mental Preparation: Understand the procedure and its potential benefits and risks. Engage in relaxation techniques, meditation, or counseling to manage anxiety and stress.
• Logistical Arrangements: Make arrangements for transportation to and from the hospital on the day of surgery, as you may not be able to drive yourself home after the procedure.
• Hospital Stay Planning: Pack a bag with essential items, including comfortable clothing, toiletries, and any personal items you may want during your hospital stay.
• Diet and Hydration: Follow any dietary instructions given by your surgical team. Staying well-hydrated and having a balanced diet can contribute to better recovery.
• Final Consultation: Have a final consultation with your surgeon to review the details of the surgery, address any last-minute concerns, and ensure that all preparations are in place.

Mitral Valve Replacement Procedure

• Anesthesia: The patient is placed under general anesthesia to ensure they are unconscious and pain-free during the surgery.
• Incision: A skilled surgeon makes an incision in the patient's chest. The location and size of the incision may vary based on the surgical approach chosen.
• Cardiopulmonary Bypass (CPB): In most cases, the surgery requires the use of a heart-lung machine, which temporarily takes over the functions of the heart and lungs. The blood is redirected away from the heart, allowing the surgeon to work on the mitral valve in a bloodless environment.
• Accessing the Heart: The surgeon gains access to the heart through the incision. This can involve separating the sternum (breastbone) and sometimes using rib spreaders to access the heart.
• Removing the Damaged Valve: The diseased or damaged mitral valve is carefully removed. The surgeon takes care to avoid damaging the surrounding tissues.
• Preparing the Valve Site: The valve site is carefully inspected and prepared to ensure proper attachment of the prosthetic valve.
• Prosthetic Valve Placement: The chosen prosthetic valve (mechanical or bioprosthetic) is securely sewn into place at the valve site. The surgeon ensures that the new valve functions properly and allows for optimal blood flow.
• Closing the Incision: After the prosthetic valve is in place and functioning correctly, the surgeon closes the incision. This may involve sutures, staples, or other closure methods.
• Weaning from the Heart-Lung Machine: If a heart-lung machine was used, the patient is gradually weaned off the machine, and the heart resumes its normal pumping function.
• Monitoring and Recovery: The patient is carefully monitored in the postoperative period. They may initially be taken to an intensive care unit (ICU) for close observation before transitioning to a regular hospital room.
• Recovery and Rehabilitation: As the patient recovers, they may participate in a cardiac rehabilitation program to gradually regain strength, mobility, and cardiovascular fitness.

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Recovery After Surgery

Recovery after mitral valve replacement surgery is a gradual process that involves healing, rehabilitation, and adjusting to the changes in your cardiovascular system. Here's what you can expect during the recovery period:

Hospital Stay

• ICU Care: Close monitoring before moving to a regular room.
• Pain Relief: Medications will help with discomfort.
• Health Checks: Vital signs, heart function, and incision will be monitored.
• Chest Tubes: Temporary drains will be removed as you heal.

Days to Weeks After Surgery

• Get Moving: Walking helps prevent clots and boosts circulation.
• Breathing Exercises: Keep lungs clear and prevent infections.
• Diet: Start with liquids, then progress to solid foods.
• Incision Care: Keep the wound clean and dry.

Weeks to Months After Surgery

• Cardiac Rehab: Helps regain strength safely.
• Slowly Increase Activity: Avoid heavy lifting at first.
• Follow-ups: Regular doctor visits ensure proper healing.
• Medication Adjustments: Dosages may change over time.

Long-Term Recovery

• Scar Care: Follow instructions to reduce scarring.
• Healthy Lifestyle: Eat well, stay active and manage stress.
• Medications: Some may need long-term blood thinners.
• Stay Alert: Report chest pain, breathing issues or irregular heartbeats.

Benefits of Mitral Valve Replacement

• Restores normal blood flow by eliminating backward leakage.
• It reduces fatigue, shortness of breath and swelling.
• Prevents Heart Failure by stopping progressive heart damage.
• Mechanical valves offer long-term survival of around 80%.
• Most of the patients return to normal activities.

Risks and Complications

Like all surgeries, mitral valve replacement carries potential risks, including:

• Infection: Infection at the surgical site or in the heart.
• Blood Clots: Increased risk of clot formation, particularly with mechanical valves.
• Valve Dysfunction: Rare complications involving the new valve.
• Bleeding: Excessive bleeding during or after surgery.
• Stroke: A small risk of stroke during surgery.
• Arrhythmias: Abnormal heart rhythms post-surgery.
• Heart Failure: Risk of ongoing heart failure symptoms.