Mitral valve surgery - minimally invasive
Definition
Mitral valve surgery is surgery to either repair or replace the mitral valve in your heart.
Blood that comes from the lungs enters the left atrium of the heart and crosses into the left ventricle. The mitral valve between these two chambers makes sure that the blood keeps moving forward. when the mitral valve is hardened (calcified), it prevents the blood from moving forward. When the mitral valve is too loose, the blood tends to flow backwards. Both of these conditions cause symptoms and may require mitral valve surgery.
Minimally invasive mitral valve surgery is done through much smaller surgical cuts than the large cuts needed for open surgery.
See also: Mitral valve surgery - open
Alternative Names
Mitral valve repair - right mini-thoracotomy; Mitral valve repair - partial upper sternotomy; Robotically-assisted, endoscopic valve repair, Percutaneous mitral valvuloplasty
Description
Before your surgery you will receive general anesthesia. This will make you unconscious and unable to feel pain.
There are several different ways to perform minimally invasive mitral valve surgery.
- Your heart surgeon may make a 2-inch to 3-inch-long cut in the right part of your chest near the sternum (breastbone). Muscles in the area will be divided so your surgeon can reach the heart. A small cut is made in the left side of your heart so the surgeon can repair or replace the mitral valve.
- In endoscopic surgery, your surgeon makes one to four small holes in your chest. Then your surgeon uses special instruments and a camera to do the surgery.
- For robotically-assisted valve surgery, the surgeon makes two to four tiny cuts (about ½ to ¾ inch) in your chest. The surgeon uses a special computer to control robotic arms during the surgery. The surgeon sees a three-dimensional view of the heart and mitral valve on the computer. This method is very precise.
You may or may not need to be on a heart-lung machine for these types of surgery, but if not, your heart rate will be slowed by medicine or a mechanical device.
If your surgeon can repair your mitral valve, you may have:
- Ring annuloplasty -- The surgeon repairs the ring-like part around the valve by sewing a ring of metal, cloth, or tissue around the valve.
- Valve repair -- The surgeon trims, shapes, or rebuilds one or both of the leaflets of the valve. The leaflets are flaps that open and close the valve.
If your mitral valve is too damaged, you will need a new valve. This is called replacement surgery. Your surgeon will remove your mitral valve and sew a new one into place. There are two main types of new valves:
- Mechanical -- made of man-made materials, such as titanium, or ceramic. These valves last the longest, but you will need to take blood-thinning medicine, such as warfarin (Coumadin) or aspirin, for the rest of your life.
- Biological -- made of human or animal tissue. These valves last 10 - 12 years, but you may not need to take blood thinners for life.
The surgery may take 2 -4 hours.
This surgery can also be done through a groin artery, with no cuts on your chest. The doctor sends a catheter (flexible tube) with a balloon attached on the end. The balloon stretches the opening of the valve. This procedure is called percutaneous valvuloplasty.
Why the Procedure Is Performed
You may need surgery if your mitral valve does not work properly because:
Minimally invasive surgery may be done for these reasons:
- Changes in your mitral valve are causing major heart symptoms, such as chest pain (angina), shortness of breath, fainting spells (syncope), or heart failure.
- Tests show that the changes in your mitral valve are beginning to seriously affect your heart function.
- Your heart valve has been damaged by infection (endocarditis).
A minimally invasive procedure has many benefits. There is less pain, blood loss, and risk of infection. You will also recover faster than you would from open heart surgery.
Percutaneous valvoplasty is a procedure that is only done in people who are too sick to have anesthesia. The results of this procedure are not long lasting.
References
Fullerton DA, Harken AH. Acquired heart disease: valvular. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2008:chap 62.
Popma JJ, Baim DS, Resnic FS. Percutaneous coronary and valvular intervention. In: Libby P, Bonow RO, Mann DL, Zipes DP, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 8th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 55.
Otto CM, Bonow RO. Valvular heart disease. In: Libby P, Bonow RO, Mann DL, Zipes DP, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 8th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 62.
Verma S, Mesana TG. Mitral-valve repair for mitral-valve prolapse. N Engl J Med. 2009; 361: 2261-2269.
Brinkman WT, Mack MJ. Transcatheter cardiac valve interventions. Surg Clin North Am. 2009;89:951-966.
Chandrashekhar Y, Westaby S, Narula J. Mitral stenosis. Lancet. 2009;374:1271-1283. Epub 2009 Sep 9.
Enriquez-Sarano M, Akins CW, Vahanian A. Mitral regurgitation. Lancet. 2009;373:1382-1394.
Review Date: 1/26/2011
Reviewed By: Shabir Bhimji, MD, PhD, specializing in General Surgery, Cardiothoracic and Vascular Surgery, Midland, TX. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. Copyright 2004 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
Alternative Names
Mitral valve repair - right mini-thoracotomy; Mitral valve repair - partial upper sternotomy; Robotically-assisted, endoscopic valve repair, Percutaneous mitral valvuloplasty
After the Procedure
Expect to spend 3 - 5 days in the hospital after surgery. You will wake up in the intensive care unit (ICU) and recover there for 1 or 2 days. Nurses will closely watch monitors that show information about your vital signs (pulse, temperature, and breathing).
Two to three tubes will be in your chest to drain fluid from around your heart. They are usually removed 1 - 3 days after surgery. You may have a catheter (flexible tube) in your bladder to drain urine. You may also have intravenous (IV, in a vein) lines to get fluids.
You will go from the ICU to a regular hospital room. Your nurses and doctors will continue to monitor your heart and vital signs until you are stable enough to go home. You will receive pain medicine for pain in your chest.
Your nurse will help you slowly resume some activity. You may begin a program to make your heart and body stronger.
A temporary pacemaker may be placed in your heart if your heart rate becomes too slow after surgery.
Outlook (Prognosis)
Mechanical heart valves do not fail often. However, blood clots can develop on them. If a blood clot forms, you may have a stroke. Bleeding can occur, but this is rare.
Biological valves tend to fail over time, but they have a lower risk of blood clots.
The results of mitral valve repair are excellent. To get the best treatment, go to a center that regularly performs this type of surgery.
Techniques for minimally invasive heart valve surgery have improved greatly over the past 10 years. These techniques are safe for most patients, and they reduce recovery time and pain.
References
Fullerton DA, Harken AH. Acquired heart disease: valvular. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2008:chap 62.
Popma JJ, Baim DS, Resnic FS. Percutaneous coronary and valvular intervention. In: Libby P, Bonow RO, Mann DL, Zipes DP, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 8th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 55.
Otto CM, Bonow RO. Valvular heart disease. In: Libby P, Bonow RO, Mann DL, Zipes DP, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 8th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 62.
Verma S, Mesana TG. Mitral-valve repair for mitral-valve prolapse. N Engl J Med. 2009; 361: 2261-2269.
Brinkman WT, Mack MJ. Transcatheter cardiac valve interventions. Surg Clin North Am. 2009;89:951-966.
Chandrashekhar Y, Westaby S, Narula J. Mitral stenosis. Lancet. 2009;374:1271-1283. Epub 2009 Sep 9.
Enriquez-Sarano M, Akins CW, Vahanian A. Mitral regurgitation. Lancet. 2009;373:1382-1394.
Review Date: 1/26/2011
Reviewed By: Shabir Bhimji, MD, PhD, specializing in General Surgery, Cardiothoracic and Vascular Surgery, Midland, TX. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. Copyright 2004 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
Alternative Names
Mitral valve repair - right mini-thoracotomy; Mitral valve repair - partial upper sternotomy; Robotically-assisted, endoscopic valve repair, Percutaneous mitral valvuloplasty
Risks
Risks for any surgery are:
Minimally invasive surgery techniques have far fewer risks than open surgery. Possible risks from minimally invasive valve surgery are:
References
Fullerton DA, Harken AH. Acquired heart disease: valvular. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2008:chap 62.
Popma JJ, Baim DS, Resnic FS. Percutaneous coronary and valvular intervention. In: Libby P, Bonow RO, Mann DL, Zipes DP, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 8th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 55.
Otto CM, Bonow RO. Valvular heart disease. In: Libby P, Bonow RO, Mann DL, Zipes DP, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 8th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 62.
Verma S, Mesana TG. Mitral-valve repair for mitral-valve prolapse. N Engl J Med. 2009; 361: 2261-2269.
Brinkman WT, Mack MJ. Transcatheter cardiac valve interventions. Surg Clin North Am. 2009;89:951-966.
Chandrashekhar Y, Westaby S, Narula J. Mitral stenosis. Lancet. 2009;374:1271-1283. Epub 2009 Sep 9.
Enriquez-Sarano M, Akins CW, Vahanian A. Mitral regurgitation. Lancet. 2009;373:1382-1394.
Review Date: 1/26/2011
Reviewed By: Shabir Bhimji, MD, PhD, specializing in General Surgery, Cardiothoracic and Vascular Surgery, Midland, TX. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. Copyright 2004 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
Review Date: 1/26/2011
Reviewed By: Shabir Bhimji, MD, PhD, specializing in General Surgery, Cardiothoracic and Vascular Surgery, Midland, TX. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. Copyright 2004 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.