What is mitral valve replacement surgery?

Mitral valve replacement is most often done as an open-heart surgery. Minimally invasive types of surgery may be another option. The damaged mitral valve is removed and replaced with a new heart valve. The damaged valve is cut out. Then the new valve is sewn in place. The new valve may be mechanical or made of animal tissue. You and your doctor can decide before surgery which type of valve is best for you.

The mitral valve opens and closes to keep blood flowing in the proper direction through your heart. When the mitral valve does not close properly, it's called mitral valve regurgitation. If the valve is very tight and narrow, it's called mitral valve stenosis. In both of these cases, blood does not flow through the heart the right way.

During valve surgery, you are given general anesthesia. In an open-chest surgery, the doctor will make a cut in the skin over your breastbone (sternum). This cut is called an incision. Then the doctor will cut through your sternum to reach your heart. In a less invasive surgery, your doctor may make a smaller cut between your ribs. Your sternum isn't cut.

The doctor will likely connect you to a heart-lung bypass machine. It adds oxygen to your blood and moves the blood through your body. This machine will allow the doctor to stop your heartbeat while working on your heart.

After replacing your mitral valve, the doctor will restart your heartbeat. Then the doctor may use wire to put your sternum back together. Your incision will be closed with stitches or staples. The wire will stay in your chest. The incision will leave a scar that will fade with time.

You may stay in the hospital for a few days after surgery.

Activity

• Rest when you feel tired. Getting enough sleep will help you recover. Try to sleep on your back while you heal. If your breastbone (sternum) was cut, healing usually takes about 4 to 6 weeks.
• Try to walk each day. Start by walking a little more than you did the day before. Bit by bit, increase the amount you walk. Walking boosts blood flow and helps prevent pneumonia and constipation.
• Avoid strenuous activities, such as bicycle riding, jogging, weight lifting, or heavy aerobic exercise, until your doctor says it is okay.
• For 3 months, avoid activities that strain your chest or upper arm muscles. This includes pushing a lawn mower or vacuum, mopping floors, or swinging a golf club or tennis racquet.
• For at least 6 weeks, avoid lifting anything that would make you strain. This may include a child, heavy grocery bags and milk containers, a heavy briefcase or backpack, or cat litter or dog food bags.
• For at least 6 weeks, avoid pushing yourself up out of a bed or chair using your arms. Do not use your arms to pull yourself into or out of a vehicle.
• Hold a pillow firmly over your chest incision when you cough or take deep breaths. This will support your chest and reduce your pain.
• Do breathing exercises at home as instructed by your doctor. This will help prevent pneumonia.
• Ask your doctor when you can drive again.
• You may need to take 4 to 12 weeks off from work. It depends on the type of work you do and how you feel.
• Ask your doctor when it is okay for you to have sex.

Diet

• Eat a heart-healthy diet. If you have not been eating this way, talk to your doctor. You also may want to talk to a dietitian. A dietitian can help you plan meals and learn about healthy foods.
• Drink plenty of fluids (unless your doctor tells you not to).
• You may notice that your bowel movements are not regular right after your surgery. This is common. Try to avoid constipation and straining with bowel movements. You may want to take a fiber supplement every day. If you have not had a bowel movement after a couple of days, ask your doctor about taking a mild laxative.

Medicines

• Your doctor will tell you if and when you can restart your medicines. You will also get instructions about taking any new medicines.
• If you stopped taking aspirin or some other blood thinner, your doctor will tell you when to start taking it again.
• Be safe with medicines. Take your medicines exactly as prescribed. Call your doctor if you think you are having a problem with your medicine.
• Take pain medicines exactly as directed.
  • If the doctor gave you a prescription medicine for pain, take it as prescribed.
  • If you are not taking a prescription pain medicine, ask your doctor if you can take an over-the-counter medicine.
  • Do not take aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve), or other nonsteroidal anti-inflammatory drugs (NSAIDs) unless your doctor says it is okay.
• If you think your pain medicine is making you sick to your stomach:
  • Take your medicine after meals (unless your doctor has told you not to).
  • Ask your doctor for a different pain medicine.
• If your doctor prescribed antibiotics, take them as directed. Do not stop taking them just because you feel better. You need to take the full course of antibiotics.
• Your doctor may give you a blood thinner to prevent blood clots. If you take a blood thinner, be sure you get instructions about how to take your medicine safely. Blood thinners can cause serious bleeding problems.

Incision care

• If you have strips of tape on the incision the doctor made, leave the tape on for a week or until it falls off.
• Wash the area daily with warm, soapy water and pat it dry. Don't use hydrogen peroxide or alcohol, which can slow healing. You may cover the area with a gauze bandage if it weeps or rubs against clothing. Change the bandage every day.
• You can take showers with your back to the showerhead. Allow the warm and soapy water to run across your shoulders and down over the incision. Pat the incision dry with a clean towel.
• Do not take a bath for the first 3 weeks, or until your doctor tells you it is okay.
• Do not swim or use a hot tub for at least 1 month, or until your doctor says it is okay.
• Do not use any creams, lotions, powders, ointments, or oils unless your doctor tells you it is okay.

Other instructions

• Keep track of your weight. Weigh yourself every day at the same time of day, on the same scale, in the same amount of clothing. A sudden increase in weight can be a sign of a problem with your heart. Tell your doctor if you suddenly gain weight, such as 3 pounds or more in 2 to 3 days.
• Be sure to tell all your doctors and your dentist that you have a replacement heart valve. This is important, because you may need to take antibiotics before certain procedures to prevent infection.

After a diseased mitral valve is replaced, the new valve works more like a normal valve and allows blood to flow more normally through the heart. Many people feel better and have a better quality of life after surgery.

The outcome of mitral valve replacement depends on a person's heart health and overall health, including other health conditions.

Surgery can be stressful. This information will help you understand what you can expect. And it will help you safely prepare for surgery.

Preparing for surgery

• Be sure you have someone to take you home. Anesthesia and pain medicine will make it unsafe for you to drive or get home on your own.
• Understand exactly what surgery is planned, along with the risks, benefits, and other options.
• If you take a medicine that prevents blood clots, your doctor may tell you to stop taking it before your surgery. Or your doctor may tell you to keep taking it. (These medicines include aspirin and other blood thinners.) Make sure that you understand exactly what your doctor wants you to do.
• Tell your doctor ALL the medicines, vitamins, supplements, and herbal remedies you take. Some may increase the risk of problems during your surgery. Your doctor will tell you if you should stop taking any of them before the surgery and how soon to do it.
• Make sure your doctor and the hospital have a copy of your advance directive. If you don’t have one, you may want to prepare one. It lets others know your health care wishes. It’s a good thing to have before any type of surgery or procedure.

The exact risks of mitral valve surgery vary depending on the person's specific condition and general health prior to surgery. Younger, healthy people have a lower risk of problems while older people with other health problems have a higher risk.

In general, the risks include:

• Effects from the surgery itself. These include:
  • Bleeding.
  • Infection.
  • Risks from anesthesia.
  • Heart rhythm problems such as atrial fibrillation.
  • Heart attack.
  • Stroke.
• Blood clots caused by the new valve. Replacement with a mechanical valve requires lifelong treatment with anticoagulant medicine to prevent dangerous blood clots.
• Infection around the replacement valve.
• Failure of the new valve. There is a small chance that the valve will not work. Your doctor will need to check from time to time to make sure that your valve is working.
• The need for another valve replacement surgery. Replacement valves last only for a limited time. Having valve surgery again will depend on what type of valve you have and how long you live after your first surgery.
• Death from the surgery. This risk can be higher or lower depending on many things such as age, heart health, and other medical problems.

You can work with your doctor to decide whether you want to have your mitral valve repaired or replaced to treat chronic mitral valve regurgitation.

Many things play a role in this decision. These things include:

• The cause of the regurgitation.
• If you have symptoms.
• If you have other health problems.
• How severe the regurgitation is.
• The shape of the mitral valve.
• The risks of the procedure or surgery.

Your personal feelings are just as important as the medical facts. Talk with your doctor about what matters most to you.

You might decide to have a procedure or surgery if the regurgitation is bad enough that you have symptoms or if it can or has damaged your heart.

If mitral valve repair is an option, it may be done with a surgery or with a catheter procedure. Valve replacement surgery might be done if the valve cannot be repaired.

Recovery from heart valve surgery usually involves a few days in an intensive care unit (ICU) of a hospital. Full recovery can take several months. Recovery includes healing of the surgical incision, gradually building physical endurance, and exercising.

You will feel tired and sore for the first few weeks after surgery. You may have some brief, sharp pains on either side of your chest. Your chest, shoulders, and upper back may ache. The incision in your chest may be sore or swollen. These symptoms usually get better after 4 to 6 weeks.

You will probably be able to do many of your usual activities after 4 to 6 weeks. But for at least 6 weeks, you will not be able to lift heavy objects or do activities that strain your chest or upper arm muscles. At first you may notice that you get tired easily and need to rest often. It may take 1 to 2 months to get your energy back.

Even though the surgery replaced your mitral valve, it is still important to eat heart-healthy foods, get regular exercise, stay at a healthy weight, take your medicine, and not smoke. Your doctor may suggest that you attend a cardiac rehab program. In cardiac rehab, a team of health professionals provides education and support to help you recover and prevent problems with your heart. Ask your doctor if rehab is right for you.

Life after surgery

After you have a replacement valve, your heart function and your life will largely return to normal. If you had symptoms before surgery, you should feel better than before you had the surgery. For example, you should no longer have shortness of breath and fatigue. But if your heart was already severely affected before your surgery, you may still have complications of heart disease.

After you recover, you should be able to resume most of your normal activities. But you'll have to continue to monitor your condition. You need to watch out for symptoms of blood clots and infections.

A mechanical or tissue valve may need to be replaced after a period of time. So be sure to see your doctor regularly.

If you have a mechanical heart valve, you are more likely to develop blood clots in your heart. So you will take an anticoagulant medicine for the rest of your life to help prevent clots.

You have had surgery to replace your heart's mitral valve. Your doctor did the surgery through a cut, called an incision, in your chest.

You will feel tired and sore for the first few weeks after surgery. You may have some brief, sharp pains on either side of your chest. Your chest, shoulders, and upper back may ache. The incision in your chest may be sore or swollen. These symptoms usually get better after 4 to 6 weeks.

You will probably be able to do many of your usual activities after 4 to 6 weeks. But for at least 6 weeks, you will not be able to lift heavy objects or do activities that strain your chest or upper arm muscles. At first you may notice that you get tired easily and need to rest often. It may take 1 to 2 months to get your energy back.

Some people find that they are more emotional after this surgery. You may cry easily or show emotion in ways that are unusual for you. This is common and may last for up to a year. Some people get depressed after this surgery. Talk with your doctor if you have sadness that continues or you are concerned about how you are feeling. Treatment and other support can help you feel better.

Even though the surgery replaced your mitral valve, it is still important to eat a heart-healthy diet, get regular exercise, stay at a healthy weight, take your medicine, and not smoke. Your doctor may suggest that you attend a cardiac rehab program. In cardiac rehab, a team of health professionals provides education and support to help you recover and prevent problems with your heart. Ask your doctor if rehab is right for you.

Mitral valve regurgitation

For acute mitral valve regurgitation, surgery is done immediately to replace or repair the valve.

For chronic regurgitation, surgery might be recommended if:

• You have symptoms.
• Regurgitation is severe.
• Your heart has pumping problems (low ejection fraction).
• Your left ventricle is larger than normal.

The decision to have surgery also depends on what caused mitral regurgitation. It depends on whether it is caused by:

• A problem with the anatomy of the valve (primary regurgitation).
• Another heart problem (secondary regurgitation).

Mitral valve stenosis

Surgery for mitral valve stenosis might be recommended if:

• Symptoms are present.
• Stenosis is severe.
• Balloon valvuloplasty is not an option.

• Follow the instructions exactly about when to stop eating and drinking. If you don't, your surgery may be canceled. If your doctor told you to take your medicines on the day of surgery, take them with only a sip of water.
• Take a bath or shower before you come in for your surgery. Do not apply lotions, perfumes, deodorants, or nail polish.
• Do not shave the surgical site yourself.
• Take off all jewelry and piercings. And take out contact lenses, if you wear them.

At the hospital or surgery center

• Bring a picture ID.
• The area for surgery is often marked to make sure there are no errors.
• You will be kept comfortable and safe by your anesthesia provider. You will be asleep during the surgery.
• The surgery will take about 3 to 5 hours.

After surgery

• You will go to the intensive care unit (ICU) right after surgery. You will probably stay in the ICU for 1 or 2 days before you go to your regular hospital room.
• You will have a breathing tube down your throat. This is usually removed within 6 hours after surgery. You will not be able to talk or drink liquids while the tube is in your throat. After the tube is removed, your throat will feel dry and scratchy. Your nurse will tell you when it is safe to drink liquids again.
• As you wake up in the ICU, the nurse will check to be sure you are stable and comfortable. It is important for you to tell your doctor and nurse how you feel and ask questions about any concerns you may have.
• You will have a thin plastic tube in a vein in your neck. This tube is called a catheter. It is used to keep track of how well your heart is working. This is usually removed in 1 to 3 days.
• You will also have a catheter in an artery in your arm. It is used to check your blood pressure and take blood samples.
• You will have chest tubes to drain fluid and blood after surgery. The fluid and extra blood are normal. They usually last for only a few days. The chest tubes are usually removed in 1 or 2 days.
• You will have several thin wires coming out of your chest near your incision. These wires can help keep your heartbeat steady after surgery. They will be removed before you go home.
• You will have a tube that drains urine from your bladder. This is called a urinary catheter. It is usually removed within 1 day.
• You may have a thin plastic tube in your nose that goes down the back of your throat into your stomach. It will drain stomach juices. It is usually removed in the days after surgery.