Mitral Valve Replacement

by Ricker Polsdorfer, MD

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 backflow or narrow and restrict blood flow. The condition can be life threatening. Sometimes the valve can be repaired. Other times, it must be replaced.

Rheumatic fever, other infections, defects at birth, and wear and tear are the most common causes of mitral valve problems.

Possible Complications

Problems from the procedure are rare, but all procedures have some risk. Your doctor will review potential problems, like:

Bleeding
Infection
Damage to the heart or other organs
Reaction to anesthesia

Factors that may increase your risk of complications include:

Smoking
Drinking
Chronic disease such as diabetes or obesity

What to Expect

Prior to Procedure

Your doctor will evaluate your general health and the condition of your heart and circulation. Some tests may include an ECG, echocardiogram, or cardiac catheterization.

Talk to your doctor about medications, herbs, or supplements you are taking. You may be asked to stop taking some medications up to 1 week before the procedure.

Do not eat or drink anything the night before your procedure.

Anesthesia

General anesthesia is given before surgery. You will be asleep.

Description of the Procedure

An incision will be made along the length of the 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 restarted. The incision will be closed.

Mitral Valve Replacement

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. Your blood pressure, pulse, and breathing will be monitored.

How Long Will It Take?

About 2 to 5 hours

How Much Will It Hurt?

Anesthesia will prevent pain during surgery. Pain and discomfort after the procedure can be managed with medications.

Average Hospital Stay

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

Postoperative Care

At the Hospital

You will probably spend 1 to 3 days in the intensive care unit (ICU) and several more days in a regular hospital room. During this time, your healthcare 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

Once you get home:

Take prescription medications such as blood thinners or antibiotics if they are prescribed by your doctor.
Antibiotics may be needed before dental procedures and during certain other procedures. This will help prevent a valve infection.
You will slowly return to your usual activities over a 4- to 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 to 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

It is important for you to monitor your recovery after you leave the hospital. Alert your doctor to any problems right away. If any of the following occur, call your doctor:

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 2 pounds in 2 days
Worsening of ankle swelling
Severe headache
Nausea 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 1 or both legs
Burning during urination

If you think you have an emergency, call for emergency medical services right away.

RESOURCES:

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

The Society of Thoracic Surgeons
http://ctsurgerypatients.org

CANADIAN RESOURCES:

Health Canada
https://www.canada.ca

Heart and Stroke Foundation of Canada
http://www.heartandstroke.com/

References:

Mitral valve disease. Society of Thoracic Surgeons website. Available at: https://ctsurgerypatients.org/adult-heart-disease/mitral-valve-disease. Accessed September 14, 2020.

Mitral valve disease: stenosis and regurgitation. Cleveland Clinic website. Available at:
...(Click grey area to select URL)
Accessed September 14, 2020.

6/2/2011 DynaMed Plus Systematic Literature Surveillance http://www.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.

Last reviewed September 2020 by EBSCO Medical Review Board Michael J. Fucci, DO, FACC
Last Updated: 9/15/2020

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