Mitral Valve Surgery Options
Two surgical options are available for the correction of mitral valve disease—mitral valve repair and mitral valve replacement. Each mitral valve surgery option has its advantages and disadvantages.
Mitral Valve Repair Surgery
According to the American Heart Association/American College of Cardiology (AHA/ACC) Guidelines for the Management of Patients with Valvular Heart Disease, in most cases, "mitral valve repair is the operation of choice when the valve is suitable for repair and appropriate surgical skill and expertise are available."
The team of cardiac surgeons at the Center for Heart Valve Disease at the Bluhm Cardiovascular Institute prefer to repair the diseased valve whenever possible because mitral valve repair surgery preserves the native valve without the need for a prosthetic valve and therefore avoids the need for blood thinning medication (except for patients in atrial fibrillation) and offers the best long-term outcome for restoring proper valve function.
Please note: This video animation shows the surgical steps involved in repairing a mitral valve. There is no audio for this video.
Performed during mitral valve surgery, there are three procedures used to repair the diseased mitral valve. The cardiac surgeon will discuss surgical options with the patient and together decide which procedure is best for the individual patient.
- Opening up the stenotic valve (commissurotomy)
- Repairing a problem with a valve leaflet (valvuloplasty)
- Tightening the opening of the leaking valve (annuloplasty)
During an annuloplasty, a prosthetic ring is placed at the base of the heart valve to provide added support to the repaired mitral valve.
Mitral Valve Replacement Surgery
If the mitral valve is damaged beyond repair, you will need to undergo surgery to replace the diseased valve with either a bioprosthetic (tissue) valve or mechanical valve. The decision to choose a tissue valve versus a mechanical valve is based on many factors including your age, lifestyle and ability to take a blood-thinning medication.
The bioprosthetic or tissue valve is made from animal (cow or pig) or human tissue. These valves do not require you to take blood-thinning medication (anticoagulant) like Warfarin unless you have other medical conditions, like atrial fibrillation, that require your blood to be thinned.
Tissue valve durability is improving and tissue valves are lasting 20 years or more without a decline in function. Tissue valves are not as durable as mechanical valves, so you may need another mitral valve replacement surgery in the future. The durability of a valve depends on your age (a tissue valve lasts longer as you age).
Mechanical valves often are made of special carbon compounds and titanium. These valves are sturdy and designed to last a lifetime. To prevent blood clots from forming on the mechanical valve, you will need to take blood-thinning medication (anticoagulant) like Warfarin for the rest of your life.
Taking blood-thinning medication may result in lifestyle modifications such as sports or activity restrictions and dietary constraints. There is an increased risk of stroke with mechanical valves, which is cumulative with each year after surgery. If you become unable to take anticoagulation medications, you would require surgery to replace the mechanical valve with a tissue valve. Taking anticoagulants increases your risk of bleeding, so you will need periodic blood tests to make sure that you are receiving the proper dose.
Valve surgery may be done in one of three ways:
- Minimally invasive—this requires the cardiac surgeon to make a small incision (about 3 inches) in the upper or lower chest and open part of your breastbone (mini-sternotomy). Using special instruments, the cardiac surgeon then repairs or replaces the valve, wires the breastbone together and closes the incision.
- Full sternotomy—this involves a 6- to 8-inch incision down the middle of your chest and requires the cardiac surgeon to open your breastbone. After surgery, the breastbone is wired together and the incision is closed with sutures.
- Thoracotomy—this involves a chest incision between the ribs.
Prior to surgery, the cardiac surgeon will discuss your plan of care, explain the available surgical options and the type of incision to be used and answer any questions.
Risks for Mitral Valve Surgery
Every surgery carries some risk. The amount depends on factors such as your age and overall health. Risks may include bleeding, infection and lung or heart problems. In some cases, a pacemaker may be needed. In rare instances, stroke or kidney failure may occur. With either a valve repair or replacement, you may need additional valve surgery at some point in your life.
Follow-up after Mitral Valve Surgery
After mitral valve surgery, it is important to comply with follow-up clinic appointments with the cardiac surgeon (1 to 2 weeks after discharge from the hospital) and a cardiologist (2 to 4 weeks after discharge from the hospital). Follow-up clinical appointments should include an echocardiogram if a baseline echocardiogram was not obtained before discharge from the hospital. If valve complications are detected with any echocardiogram, further follow-up is indicated.
The time between a patient's follow-up clinical appointments depends upon the patient's individual health needs. Patients should ask their cardiac surgeon and/or cardiologist when their next follow-up appointment should be scheduled.
For more information regarding mitral valve disease and the treatments available, please contact the Bluhm Cardiovascular Institute at 1-866-662-8467 or request a first time appointment online.
Among the Nation's Best
In 2013-14 U.S. News & World Report ranked our Cardiology and Heart Surgery program #12 in the nation and the highest ranked program in Illinois for the sixth straight year.