Minimally Invasive Mitral Valve Repair

What is a minimally invasive mitral valve repair?

A minimally invasive mitral valve repair is surgery to fix your mitral valve. The mitral valve keeps blood flowing in the correct direction between your lower left heart chamber (left ventricle) and your upper left heart chamber (left atrium). You may need a mitral valve repair if your mitral valve isn’t working properly.

If your surgeon performs the minimally invasive mitral valve repair with the surgical robot, your surgeon will insert tiny surgical tools and cameras through one or more small chest incisions. This approach is less invasive than traditional open-heart surgery, which uses a long incision down the front of your chest.

What does a minimally invasive mitral valve repair treat?

You may need a mitral valve repair if you have:

• Mitral valve regurgitation: The flaps in your mitral valve don’t close properly between heartbeats, which allows blood to leak backward.
• Mitral valve stenosis: The flaps in your mitral valve stiffen and may even fuse. This decreases blood flow and narrows your mitral valve.

What is the difference between a mitral valve repair and a mitral valve replacement?

In a mitral valve repair, your surgeon fixes a problem in your mitral valve but doesn’t remove the mitral valve. In a mitral valve replacement, your surgeon replaces your own valve with a mechanical valve or one made from pig or cow tissue.

What are the types of minimally invasive mitral valve repair procedures?

Your surgeon may use several techniques to repair your mitral valve with minimally invasive surgery. They may perform an annuloplasty — tightening a leaky mitral valve by placing a mesh or metal ring around it.

Your surgeon may also:

• Connect the valve’s flaps more securely.
• Fix a hole in your heart valve.
• Remove excess tissue that’s preventing valve flaps from closing properly.
• Separate valve flaps that have joined.

Who is a candidate for minimally invasive mitral valve surgery?

People with mitral valve regurgitation or stenosis may be candidates for minimally invasive mitral valve surgery. Whether you are a candidate depends on several factors, including:

• Your heart’s condition.
• Whether you need other procedures at the time of mitral valve surgery.
• Lifestyle: Some people, such as those who smoke or have a body mass index (BMI) above 30, may not be good surgical candidates.
• Medical history: You may not be a surgery candidate if you have severe coronary artery disease or aortic valve disease.

What happens before minimally invasive mitral valve repair?

Your surgeon gives you instructions to prepare for a minimally invasive mitral valve repair. You may have tests such as an echocardiogram to evaluate blood flow through your heart and get a closer look at your heart valves. You may also need a cardiac catheterization to examine the arteries on your heart and a CT (CAT) scan.

What happens during minimally invasive mitral valve repair?

During a minimally invasive mitral valve repair, your cardiac (heart) surgeon:

1. Makes a 4- to 6-centimeter incision along your ribs on one side.
2. Inserts a tool with a camera on the end (endoscope) through the incisions to view your mitral valve.
3. Uses small surgical tools to repair the mitral valve.
4. Closes the incisions with stitches.

How long does minimally invasive mitral valve repair surgery take?

Minimally invasive mitral valve repair typically takes between two and four hours.

What happens after minimally invasive mitral valve repair?

You spend one to two days in the intensive care unit (ICU) after a mitral valve repair. You may temporarily have drainage tubes in your chest to keep fluid from building up around your heart.

You move from the ICU to another hospital area to continue recovery for a few more days. Your surgical team helps you get up and walk a day or two after surgery. They may instruct you to perform breathing exercises to remove any fluid in your lungs. You can expect to spend up to five days in the hospital before returning home.

What are the advantages of minimally invasive mitral valve repair?

Minimally invasive mitral valve surgeries can successfully treat mitral valve problems while also offering benefits of:

• Faster healing and recovery time.
• Less pain and reduced reliance on opioids.
• Lower risk of infection or blood loss.
• Reduced scarring.
• Shorter hospital stays.

What are the risks or complications of minimally invasive mitral valve repair?

Minimally invasive mitral valve repair can pose risks such as:

• Bleeding and blood clots.
• Infection.
• Irregular heart rhythms (arrhythmias).
• Stroke.

What is the recovery time after minimally invasive mitral valve repair?

You may feel more tired than usual for a few weeks after surgery. Your surgeon gives you instructions about when you can return to work and other activities at this follow-up appointment. You’ll need to avoid heavy lifting for several weeks.

Your provider may also recommend that you complete a cardiac rehabilitation program. These programs help you increase your activity levels safely. They may also help you adopt healthier habits, such as a nutritious diet and regular exercise.

When should I see my healthcare provider?

See your healthcare provider right away if you experience any signs of complication after mitral valve surgery, including:

• Drainage or pus around the incision site.
• Excessive swelling or redness around the incision site.
• Fever or chills.
• Heart palpitations.
• Unusual swelling or fluid retention (edema) in your legs or feet.
• Weight gain of more than 3 pounds in one week.

Can the mitral valve be repaired without standard open-heart surgery?

Yes. Your surgeon may repair your mitral valve using minimally invasive techniques, depending on your diagnosis and the condition of your heart and valve.

They may also use catheter-based procedures (percutaneous interventions). In catheter procedures, your provider inserts a long, hollow tube (catheter) through a blood vessel in your groin and guides it to your heart. They thread surgical tools through the catheter to repair your mitral valve.

A note from Cleveland Clinic

A minimally invasive mitral valve repair is surgery to fix a problem with your mitral valve. Surgeons operate through one or more small incisions instead of one long incision down the center of your chest. The minimally invasive approach often offers shorter hospital stays, faster recovery and less pain.