Royal North Shore Hospital
North Shore Private Hospital
Suite 3a Level 4
North Shore Private Hospital
St Leonards NSW 2065
F: 02 8076 3073
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.
Mitral valve replacement is indicated for patients with mitral stenosis and in some cases for mitral regurgitation. The faulty valve is replaced with an artificial valve from these two broad categories: tissue valves and mechanical valves.
Generally, patients under the age of 60 will choose a mechanical valve and patients older than 65 will choose a tissue valve due to the differences in longevity of the valves and the need to be on blood thinners. In younger patients, tissue valves are found to be less durable for reasons that aren’t completely clear but may relate to their stronger immune system. When the valve fails a repeat surgery is generally required to place a new valve.
A mechanical valve will essentially last forever mechanically but requires the blood thinner warfarin for life. This is because the natural blood clotting system ‘sees’ the mechanical valve as foreign and will form a clot. If there is clot formation on a valve it can cause a catastrophic failure. Warfarin is a strong blood thinner that requires regular blood testing to monitor its effect and increases the risk of bleeding with trauma and surgery.
Ultimately, the choice of valve is individual and Dr Bassin will discuss this with each patient in detail.
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.
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.