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Mitral Valve Replacement

Definition

The mitral valve is on the left side of the heart. It allows blood to flow from the left upper chamber into the left lower chamber. When the valve is not working well, it may need to be replaced.

Reasons for Procedure

Healthy heart valves allow blood to flow one way. Diseased valves either leak and cause back flow or narrow and restrict flow. The condition can be life threatening. Sometimes the valve can be repaired. Other times, it must be replaced.
Rheumatic fever, infections, defects at birth, and wear and tear are the most common causes of mitral valve problems.

Possible Complications

If you are planning to have a mitral valve replacement, your doctor will review a list of possible complications, which may include:
  • Bleeding
  • Infection
  • Damage to the heart or other organs
  • Reaction to anesthesia
Before your procedure, talk to your doctor about ways to manage factors that may increase your risk of complications such as:
  • Smoking
  • Drinking
  • Chronic disease such as diabetes or obesity
Your risk of complications may also be increased if you have:

What to Expect

Prior to Procedure

Your doctor will evaluate both your general health and the condition of your heart and circulation. Expect several heart tests, including an electrocardiogram (EKG) and an echocardiogram using ultrasound. Some patients may also have cardiac catheterization.
Leading up to your procedure:
  • Talk to your doctor about your medicines, herbs, or supplements. You may be asked to stop taking some medicines up to one week before the procedure, such as:
    • Aspirin or other anti-inflammatory drugs
    • Blood-thinning medicines
  • Do not eat or drink anything the night before your procedure.

Anesthesia

You will have a general anesthetic. You will be asleep.

Description of the Procedure

An incision will be made along the length of your breast bone. The breast bone will be split lengthwise to expose your heart. You will then be put on a heart-lung machine. This machine takes over the work of your heart so that the doctor can stop your heart.
Your heart will be opened. A substitute valve will be sewn into place. This valve may be mechanical (metal and plastic), such as a St. Jude valve, or it may be made of tissue. Tissue valves most often come from a pig or a cow. Tissue valves may also be supplied by a human donor or even manufactured from your own tissues. When the valve is in place, you will be taken off the heart-lung machine and your heart will be re-started. The incision will be closed.
Mitral Valve Replacement
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Newer techniques, including robot-assisted procedures, are being developed. These procedures will be able to do the same surgery with smaller incisions.

Immediately After Procedure

You will be taken to a recovery room. You will be monitored for any negative reactions.

How Long Will It Take?

About 2-5 hours

How Much Will It Hurt?

Anesthesia will block pain during the surgery. Your chest and back will be sore following the surgery. Talk to your doctor about medicine to help manage pain.

Average Hospital Stay

The usual length of stay is 8-10 days. Your doctor may choose to keep you longer if complications arise.

Postoperative Care

At the Hospital
You will probably spend 1-3 days in the intensive care unit (ICU) and several more days in a regular hospital room. During this time, your care team will:
  • Observe you for any complications
  • Stabilize your heart function
  • Instruct you in home care and activities
During your stay, the hospital staff will take steps to reduce your chance of infection such as:
  • Washing their hands
  • Wearing gloves or masks
  • Keeping your incisions covered
There are also steps you can take to reduce your chances of infection such as:
  • Washing your hands often and reminding visitors and healthcare providers to do the same
  • Reminding your healthcare providers to wear gloves or masks
  • Not allowing others to touch your incisions
At Home
Be sure to follow your doctor's instructions, which may include:
  • If you have a mechanical valve, you will need to take blood thinners for life. This will help to prevent blood clots. If you have a tissue valve, you will need to take blood-thinning medicine for six weeks to three months after surgery.
  • You may also need to take antibiotics during dental procedures and during certain other procedures. This will help prevent a valve infection.
  • Ask your doctor about when it is safe to shower, bathe, or soak in water.
  • You will slowly return to your usual activities over a 4-12 week period. You may also be asked to participate in a cardiac rehabilitation program.
Mechanical valves can last a lifetime. Tissue valves last 7-14 years and then must be replaced. If your valve is repaired and you have no complications, you will likely do well and be able to return to normal activities.

Call Your Doctor

After you leave the hospital, contact your doctor if any of the following occurs:
  • Signs of infection, including fever and chills
  • Redness, swelling, increasing pain, excessive bleeding, or any discharge from the incision site
  • Constipation, diarrhea, bloody or tarry-color bowel movements, or stomach pain
  • Weight gain—greater than two pounds in two days
  • Worsening of ankle swelling
  • Severe headache
  • Nausea and/or vomiting
  • Cough, shortness of breath, or chest pain
  • Coughing up blood
  • Skin rash, or unusual bruising or bleeding
  • Confusion
  • Lightheadedness when standing
  • Tingling in hands and feet
  • Irregular heartbeat, extremely slow pulse, or fast pulse
  • Redness, swelling, or pain in one or both legs
  • Burning during urination
In case of an emergency, call for medical help right away.

RESOURCES

American Heart Association http://www.heart.org

The Society of Thoracic Surgeons http://www.sts.org

CANADIAN RESOURCES

Health Canada http://www.hc-sc.gc.ca

Heart and Stroke Foundation of Canada http://ww2.heartandstroke.ca

References

Mitral valve disease: stenosis and regurgitation. Cleveland Clinic website. Available at: http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/cardiology/mitral-valve-disease/. Accessed May 16, 2013.

Mitral valve repair. Society of Thoracic Surgeons website. Available at: http://www.sts.org/doc/4107. Accessed May 16, 2013.

6/3/2011 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Mills E, Eyawo O, Lockhart I, Kelly S, Wu P, Ebbert JO. Smoking cessation reduces postoperative complications: a systematic review and meta-analysis. Am J Med. 2011;124(2):144-154.e8.

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