Mitral Valve Replacement

Mitral valve replacement is an open-heart surgery to improve blood flow by replacing an ailing mitral valve with one made from metal or animal tissue. You may receive a mechanical (artificial) replacement valve made of carbon and steel. Or you may get a biological (bioprosthetic) valve made of tissues from pigs, cows or (rarely) humans.

Your mitral valve is the passageway between the two chambers of your heart that hold oxygen-rich blood. This blood travels from your lungs into your left atrium, through your mitral valve and into your left ventricle. Your left ventricle has the important job of pumping blood out to your body through your aorta.

If you have mitral valve disease, your valve can’t open and close properly. This puts a strain on the left side of your heart. Over time, this can lead to heart and lung damage.

Like all open-heart surgeries, mitral valve replacement surgery comes with risks. But if your healthcare provider recommends this surgery, it means your valve disease is getting worse and you’re at risk for serious complications. It also means they can’t repair your valve.

What does this procedure treat?

A mitral valve replacement operation treats mitral valve regurgitation and mitral valve stenosis. Surgeons will try to repair your valve, rather than replace it, whenever possible. Your surgeon may recommend a new valve if repair surgery has a low chance of success. Reasons for this may include:

• Severe damage from endocarditis or rheumatic heart disease
• Extensive calcium deposits or scarring
• A lot of damage to your papillary muscles or chordae, which support your valve

Talk with your provider about your options. It’s a good idea to go to a high-volume hospital (where surgeons perform many valve surgeries every day) for evaluation. Surgeons at these hospitals are experienced in evaluating valve anatomy. They’re highly skilled at deciding if repair or replacement would be better for you.

Choosing a replacement mitral valve type

Valve types include:

• Mechanical valves: These last 20 to 30 years, so they’re good for people under 50. But you’ll need to take blood thinners (anticoagulants) for the rest of your life. Taking blood thinners can be risky for some people, like those who are pregnant or have a greater risk of falls or injuries.
• Biological valves: These only last 10 to 20 years, but you’ll only need to take blood thinners for up to three months after surgery. (There’s a lower risk of blood clots, which is good for people over 65.)

If you’re between 50 and 65, your provider may recommend an artificial or biological type of valve, depending on your situation.

How common is this procedure?

Heart valve surgery is the second most common heart surgery in the U.S.

In the U.S., about 90,000 people have one of their heart valves replaced each year. Around the world, this number is about 280,000. The most commonly replaced valves are the mitral valve and the aortic valve.

How should I prepare for this procedure?

Your provider will give you specific instructions for how to prepare for your surgery. In general, you’ll need to:

• Stop taking certain medications in the weeks before your surgery
• Stop smoking and using tobacco products (your provider can give you resources to quit)
• Wash your body with an antimicrobial soap the night before your surgery
• Stop eating and drinking after a specific time (usually midnight the night before your surgery)
• Take certain medications on the day of your surgery

Your provider may also give you medications to treat conditions like congestive heart failure and atrial fibrillation before your surgery.

As your surgery day approaches, you should also prepare for your return home. For example, it’s important to put everyday items within easy reach and find someone to drive you home from the hospital.

What happens during mitral valve replacement?

During a mitral valve replacement operation, your surgeon will remove your damaged valve and put a new one in its place. Throughout the surgery, your care team will use transesophageal echocardiography. This imaging technology guides their work and helps them confirm surgery success.

During a mitral valve replacement procedure, your surgeon will:

1. Give you anesthesia so you’ll be asleep during the surgery (you won’t remember the surgery when you wake up)
2. Connect you to monitors and give you antibiotics through an IV
3. Connect you to a cardiopulmonary bypass machine that does the work of your heart and lungs during the surgery (your heart won’t be beating during the surgery)
4. Make an incision in your chest (most valve replacements require a sternotomy to access your heart)
5. Make an incision in your left atrium to reach your mitral valve
6. Remove damaged tissue using surgical techniques that preserve as much of your natural tissue as possible, which can help the new valve and your left ventricle work better
7. Sew your new valve into place — the specific suturing techniques depend on the type of valve you receive
8. Check to be sure the valve’s leaflets can move freely (it’s important that no tissue gets in the way as your valve closes)
9. Sew your left atrium closed and slowly ease you off the cardiopulmonary bypass machine

Your surgery will include additional steps if you’re having other procedures done at the same time.

Mitral valve replacement surgery generally takes two to four hours.

What are the potential benefits and risks of this procedure?

The advantages of mitral valve replacement include:

• It doesn’t take as long as repair surgery. You’ll spend less time on the cardiopulmonary bypass machine.
• It’s less complex to perform than repair surgery (though it’s still very complex).
• It lowers your risk of needing another surgery in the future.

Complications of mitral valve replacement surgery include, but aren’t limited to:

• Abnormal heart rhythms (arrhythmias)
• Bleeding
• Blood clots
• Heart block
• Heart failure
• Infection
• Stroke

These complications may happen soon after your surgery or later. Talk with your provider about all possible complications and how to lower your risk.

What happens after this procedure?

Most people need to spend about a week in the hospital after a mitral valve replacement. After your surgery, you can expect to:

• Spend one or two days in the intensive care unit, where your care team will keep a close eye on you (they’ll check your pulse, breathing and other vitals)
• Spend several more days in a hospital room
• Receive treatment like medicine or a temporary pacemaker for an arrhythmia (abnormal heart rhythm), which is very common after valve replacement
• Begin taking anticoagulants to reduce your risk of a blood clot
• Learn about cardiac rehab, which can help you get back on your feet again faster
• Learn how to care for your incision as you continue recovering at home

What is the recovery time?

Recovery from mitral valve replacement surgery usually takes four to eight weeks. Some people may need more time.

Several factors impact your recovery. These include:

• The severity of mitral valve disease before your surgery: If you had severe regurgitation or reduced heart function, you may need more time to get your strength back.
• Your general health before your surgery: If you had heart failure or kidney failure, you’ll likely face a slower recovery.
• The nature of the surgery: If you had valve replacement along with other procedures, your recovery may be slower.

Don’t push yourself to recover within a certain time frame. Recovering from heart surgery takes time. Everyone is different. Let your body rest, and accept help from others as you heal.

Your provider will tell you when it’s safe for you to drive, lift heavy objects or take walks.

After a mitral valve replacement, it’s important to make caring for your heart part of your lifestyle. This includes:

• Eating heart-healthy foods
• Avoiding tobacco products
• Avoiding beverages that contain alcohol
• Staying at a weight that’s healthy for you
• Getting regular physical activity

What is the life expectancy?

Almost everyone survives mitral valve replacement surgery, but the risks go up as you get older. About half of people who have this surgery live at least 10 more years. This is true whether they receive a biological valve or a mechanical one.

Your life expectancy after mitral valve replacement depends on many factors. As with any surgery, your age and overall health play a role. Your long-term survival is better if:

• You only need a valve replacement
• It’s your first time having valve replacement surgery
• Your surgery is elective (not an emergency)
• You have some healthy valve tissue for surgeons to keep and attach to your new valve

Talk with your provider about your situation and how long you can expect to live after your valve replacement. No provider can predict the exact number of years. But they’ll be able to assess your personal risks and give you a realistic picture of your outlook.

When should I call my healthcare provider?

Your provider will tell you when you need to return for follow-up appointments. It’s important to keep these appointments so your provider can check how your new valve is working.

As you recover, stay aware of how you’re feeling. Call your provider right away if you have any signs or symptoms of complications. These include:

• Chest pain
• Chills, fever or other signs of infection, like oozing from your incision
• Coughing up blood or mucus that looks yellow or green
• Dizziness or fainting
• Headache that’s very severe
• Irregular pulse (too slow or too fast)
• Nausea and vomiting
• Pain, redness or swelling in your lower leg
• Pain around your incision that won’t go away
• Shortness of breath
• Slurred speech or other signs of a stroke

If you’re taking blood thinners, you should call your provider if you fall, have excessive bleeding or have many bruises.

Don’t hesitate to call your provider, even if you think everything’s probably fine. Your provider will know if a symptom that seems minor is actually a cause for concern.

How serious is mitral valve replacement surgery?

Your heart is a major organ that keeps you alive, so any surgery on it is serious. Highly experienced cardiac surgeons have the skills and training to minimize your risks.

Can the mitral valve be replaced without open-heart surgery?

Usually, mitral valve replacement involves open-heart surgery. But some people are candidates for transcatheter mitral valve repair or replacement (TMVR). This is a minimally invasive procedure that treats your valve from inside your body. TMVR allows you to avoid open-heart surgery. Your provider will let you know if this is an option for you.

Robotic valve replacement is another option. This involves using robotic assistance to replace your valve without having to cut bone in the chest cavity like a standard sternotomy.