Mitral valve surgery - open
Definition
Mitral valve surgery is surgery that can either repair or replace the mitral valve in your heart.
Blood that flows between different chambers of your heart must flow through a valve. One such valve is called the mitral valve. It opens up enough so blood can flow from one chamber of your heart (left atria) to the next chamber (left ventricle). It then closes, keeping blood from flowing backwards.
In open surgery, the surgeon makes a large cut in your breastbone to reach the heart.
See also: Mitral valve surgery - minimally invasive
Alternative Names
Mitral valve replacement - open; Mitral valve repair - open; Mitral valvuloplasty
Description
Before your surgery, you will receive general anesthesia. This will make you asleep and pain-free during the entire procedure.
- Your surgeon will make a 10-inch-long cut in the middle of your chest.
- Next, your surgeon will separate your breastbone to be able to see your heart.
- Most people are connected to a heart-lung bypass machine or bypass pump. Your heart is stopped while you are connected to this machine. This machine does the work of your heart while your heart is stopped.
- A small cut is made in the left side of your heart so your surgeon can repair or replace the mitral valve.
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 more of the three 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 types of mitral valves:
- Mechanical -- made of man-made (synthetic) materials, such as a metal like titanium. 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 to 12 years, but you may not need to take blood thinners for life.
Once the new or repaired valve is working, your surgeon will:
- Close your heart and take you off the heart-lung machine.
- Place catheters (tubes) around your heart to drain fluids that build up.
- Close your breastbone with stainless steel wires. It will take about 6 weeks for the bone to heal. The wires will stay inside your body.
You may have a temporary pacemaker connected to your heart until your natural heart rhythm returns.
Your surgeon may also perform coronary artery bypass surgery at the same time, if needed.
This surgery may take 3 - 6 hours.
Why the Procedure Is Performed
You may need surgery if your mitral valve does not work properly.
- A mitral valve that does not close all the way will allow blood to leak back into the left atria. This is called mitral regurgitation.
- A mitral valve that does not open fully will restrict blood flow. This is called mitral stenosis.
- A valve defect that you have had since birth is called mitral valve prolapse.
You may need open-heart valve surgery for these reasons:
- Changes in your mitral valve are causing major heart symptoms, such as angina (chest pain), 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 doctor may want to replace or repair your mitral valve at the same time as you are having open-heart surgery for another reason.
- Your heart valve has been damaged by endocarditis (infection of the heart valve).
- You have received a new heart valve in the past, and it is not working well, or you have other problems such as blood clots, infection, or bleeding.
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.
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.
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 replacement - open; Mitral valve repair - open; Mitral valvuloplasty
After the Procedure
Expect to spend 4 to 7 days in the hospital after surgery. You will wake up in the intensive care unit (ICU) and recover there for 1 or 2 days. Two to three tubes will be in your chest to drain fluid from around your heart. They are usually removed 1 to 3 days after surgery.
You may have a flexible tube (catheter) in your bladder to drain urine. You may also have intravenous (IV, in the vein) lines to get fluids. Nurses will closely watch monitors that show information about your vital signs (pulse, temperature, and breathing).
You will be moved to a regular hospital room from the ICU. 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 to control pain around your surgical cut.
Your nurse will help you slowly resume some activity. You will be asked to begin a physical therapy program to make your heart and body stronger.
Outlook (Prognosis)
Mechanical heart valves do not fail often. They last from 12 to 20 years. However, blood clots 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.
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.
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.
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 replacement - open; Mitral valve repair - open; Mitral valvuloplasty
Risks
Risks for any surgery are:
Possible risks from having open-heart surgery are:
- Heart attack or stroke
- Heart rhythm problems
- Infection in the cut, which is more likely to happen in people who are obese, have diabetes, or have already had this surgery
- Memory loss and loss of mental clarity, or "fuzzy thinking."
- Post-pericardiotomy syndrome, which is a low-grade fever and chest pain. This could last for up to 6 months.
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.
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.
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.