Mitral Valve Surgery
Who needs this procedure?
Patients who have severe mitral valve regurgitation require surgery if they are symptomatic with shortness of breath or where the heart is enlarging due to the backflow of blood. Patients with severe mitral stenosis require surgery if there are significant symptoms and the valve cannot be fixed by an interventional cardiologist with a balloon dilatation.
Minimally invasive mitral repair or replacement (mini mitral) can be performed if there is no need for other valve or coronary bypass surgery at the same time.
What is involved?
Minimally invasive mitral surgery can be performed with robotic assistance or specialised minimally invasive instruments.
Under general anaesthetic a small incision is made in the right chest to access the heart. Another small incision is made in the right hip crease to connect the patient to the heart-lung machine. The heart is then stopped and the mitral valve repaired or replaced via the small incision.
Before a decision is made to perform the surgery minimally invasively, a number of tests are performed to ensure the safety of the patient. The main tests include a coronary angiogram to ensure that bypass surgery isn’t required and a CT scan of the entire arterial system to ensure that the leg artery (femoral artery) is safe to use for the heart-lung machine.
What is the recovery like?
The recovery after minimally invasive surgery is far more rapid than traditional open heart surgery. The operation takes 3-4 hours and you will generally wake up in intensive care later that day. 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. Most minimally invasive patients can go home after 4-5 days.
Once at home, patients who have undergone minimally invasive surgery continue to recover a lot faster than those who have undergone open heart surgery with splitting of the breastbone. Mobilisation is far easier and there aren’t any restrictions on lifting. Once at home, patients are encouraged to take plenty of walks. Your body will let you know what it’s capable of and there is no need to push it. Most patients will feel back to their usual selves after about 4 weeks following minimally invasive surgery compared with 3 months following traditional open heart surgery.
What are the benefits and risks of this procedure?
Although the operation is performed minimally invasively, there are still some of the usual risks associated with major heart surgery. The main benefits are that there is no risk of sternal bone infection, and there is a reduced rate of blood transfusion. Other risks are similar to open valve surgery including: death (1%), stroke (1%), kidney injury (2%) and blood transfusion (15%). The risk can be higher if patients have other co-morbidities including advanced age, previous heart disease or stroke or lung disease.
Dr Bassin will explain these risks to each patient in person and how they pertain to their specific condition.