Obesity and Bariatric Surgery

Mitral Valve Replacement: Minimally Invasive

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. It's called minimally invasive because it uses a single small cut (incision) and special tools 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 is between the 2 chambers of the heart on the left side. These 2 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. It does this without putting extra stress on the heart.

Why might I need a minimally invasive mitral valve replacement?

If the mitral valve isn't working well, you may need it fixed or replaced. Fixing the mitral valve is often possible. But sometimes it must be replaced.

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

Mitral valve stenosis. The valve can't open fully. This means less blood is able to move from the left atria into the left ventricle.
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 severe tiredness (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, 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 own risks will vary based on your overall health, age, and other factors. Possible risks include:

Infection
Bleeding
Irregular heart rhythms, possibly requiring a lifelong (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 things increase the risk of complications, such as:

Long-term (chronic) illness
Other heart conditions
Lung problems
Being older
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. These are made mainly from pig, cow, or human heart tissue. Biological valves may not last as long as mechanical valves. You'll need to take blood thinners for a time after surgery, but not for life.
Mechanical valves. These are manmade. If you have a mechanical valve, you'll need to take blood thinners for the rest of your life.

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

Follow any directions you're given for not eating or drinking before your surgery.
Try to stop smoking before your surgery. Ask your healthcare provider for ways to help.
Ask your provider if you need to stop taking certain medicines before your surgery. Tell your provider if you often take blood-thinning medicines like warfarin or aspirin. Ask which medicines should be stopped before surgery, and when. Also ask which medicines should be continued.
Tell your provider about all other medicines you're taking. This includes prescription and over-the-counter medicines. It also includes vitamins, herbs, and supplements.
Tell your provider if you're sensitive to or are allergic to any medicines, iodine, latex, tape, or anesthetic agents (local and general).
Tell your provider if you're pregnant, or think you could be pregnant.

Follow your healthcare provider's instructions about when to come to the hospital before your surgery. 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 procedure, you'll likely get medicines to help you relax. In most cases your surgery will proceed as planned. But sometimes another emergency might delay it.

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'll 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 special tools and a tiny camera through the incision to do the surgery. Some surgeons use robot-controlled arms to do the surgery. Your provider will review all of your options with you along with their risks and benefits.
During the procedure, you'll 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 slowly 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'll begin your recovery in the intensive care unit (ICU) or a recovery room.
When you wake up, you might feel confused at first. You might wake up a few hours after the surgery, or a little later.
Most people who have mitral valve replacement often notice symptom relief right away after their surgery.
The team will carefully watch your vital signs, such as your heart rate. You may be hooked up to a few machines. This lets the nurses check your vital signs 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 often 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 in a few 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'll likely be encouraged to get up and sit in a chair. You should be able to walk with help in 1 or 2 days.
You may do breathing therapy to help remove fluids that collect in your lungs during surgery.
You'll likely be able to drink liquids once the breathing tube is removed, often 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. This is to help blood circulate through your leg veins.
You'll likely need to stay in the hospital for a few days. This may vary from person 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'll likely 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'll slowly start to get your strength back. Recovery time after this surgery tends to be less than for an open surgery.
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 provider if you have shortness of breath or swelling in your legs.
Ask your provider about when it's safe for you to drive.
Don't lift anything heavy for several weeks. Ask your provider about what is safe for you to lift.
Follow all the instructions your 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.
Your provider may advise you to begin a cardiac rehab (rehabilitation) program. This slowly gets you back to a normal lifestyle. Cardiac rehab starts in the hospital with simple walking. The program progresses to a regular exercise routine and a nutritious diet. Committing to healthier habits can prevent future heart problems.