Who needs this procedure?
If someone has severe mitral regurgitation or mitral stenosis they may require surgery to repair or replace the mitral valve. Symptoms that can be noticed with mitral valve disease include shortness of breath, particularly on exertion or when walking up a hill or stairs. Other common symptoms are heart palpitations when the heart feels like it is ‘racing’ or beating irregularly.
Mitral valve disease can ultimately result in heart failure and this can present shortness of breath at rest, the inability to lie flat, waking up in the middle of the night short of breath and leg swelling.
Patients who have severe mitral regurgitation and have symptoms should undergo assessment by a cardiothoracic surgeon for consideration of mitral valve repair or replacement. Patients who don’t have symptoms are monitored regularly by their cardiologist. If the heart starts to fail or enlarge even without symptoms, surgery should be considered.
What is involved?
Open mitral valve surgery is performed under general anaesthetic through a vertical incision down the middle of the breastbone (sternum) to expose the heart. The patient is connected to a heart-lung machine, which pumps blood through the body whilst the heart is stopped to operate on it. The mitral valve is accessed and repaired or replaced according to its condition. The operation takes approximately 3-4 hours.
Mitral Valve Repair
In most cases of mitral regurgitation, the valve can be repaired by using a number of complex techniques to reconstruct its function. Mitral valve repair has been associated with improved long-term survival because the heart function is preserved with the more natural function of a repaired native valve. There is also a reduced chance of infection compared with replacement as there is far less foreign material for bacteria to grow on. Another significant consideration is that for younger patients, valve repair means that they can live without the blood thinner warfarin which would have been required for a mechanical (metal) valve replacement.
What is the recovery like?
The operation takes approximately 3-4 hours and you will wake up in intensive care later that day or the next morning. Small tubes to drain any residual fluid from around the heart will be placed in your neck, as well as intravenous lines, to sample blood and administer medications. These tubes and lines will be removed after 1-2 days and then you will be transferred to the ward to continue your recovery.
Once on the ward, the goal is to monitor your blood pressure and heart rate and ensure adequate mobilisation. We work very closely with our nurses, physiotherapists and occupational therapists to work on breathing exercises and functional mobilisation. Every patient is different and the assistance is tailored to your needs. Many patients are discharged home after a week but there is a significant number of patients, particularly the elderly who find it easier to transition home after a short stay in a rehabilitation hospital.
Once at home, patients are encouraged to take plenty of walks and to generally take it easy. Your body will let you know what it is capable of and there is no need to push it during this recovery period.
For the first 6 weeks there are precautions to be taken whilst the bone is healing. Lifting should be limited to 3kg and patients are encouraged to sleep on their back. Any activity that requires heavy use of the arms is generally discouraged.
Patients generally go back to work after 4-6 weeks and complete recovery is achieved by 3 months.
What are the benefits and risks of this procedure?
Mitral valve replacement has been performed since the 1960s with excellent results. We have continued to improve the safety of surgery but there are still risks. For patients who are otherwise well the risks of surgery include: death (1%), stroke (1%), significant wound infection (1%), kidney injury (2%), requirement for a permanent pacemaker (3%) and blood transfusion (25%). The risk can be higher if patients have other co-morbidities including advanced age, previous heart disease or stroke, lung disease or having undergone cardiac surgery previously.
Dr Bassin will explain these risks to you in person as they pertain to your condition.
When can I drive?
You may drive 4 weeks following surgery, according to the national guidelines.