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Definition  

The mitral valve is on the left side of the heart. It allows blood to flow from the left upper chamber into the left lower chamber. When the valve is not working well, it may need to be replaced.

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Reasons for Procedure  

Healthy heart valves allow blood to flow one way. Diseased valves either leak and cause back flow or narrow and restrict flow. The condition can be life threatening. Sometimes the valve can be repaired. Other times, it must be replaced.

Rheumatic fever, infections, defects at birth, and wear and tear are the most common causes of mitral valve problems.

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Possible Complications  

If you are planning to have a mitral valve replacement, your doctor will review a list of possible complications, which may include:

  • Bleeding
  • Infection
  • Damage to the heart or other organs
  • Reaction to anesthesia

Before your procedure, talk to your doctor about ways to manage factors that may increase your risk of complications such as:

  • Smoking
  • Drinking
  • Chronic disease such as diabetes or obesity

Your risk of complications may also be increased if you have:

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What to Expect  

Prior to Procedure  

Your doctor will evaluate both your general health and the condition of your heart and circulation. Expect several heart tests, including an electrocardiogram (EKG) and an echocardiogram using ultrasound. Some patients may also have cardiac catheterization.

Leading up to your procedure:

  • Talk to your doctor about your medicines, herbs, or supplements. You may be asked to stop taking some medicines up to one week before the procedure, such as:
    • Aspirin or other anti-inflammatory drugs
    • Blood-thinning medicines
  • Do not eat or drink anything the night before your procedure.

Anesthesia  

You will have a general anesthetic. You will be asleep.

Description of the Procedure  

An incision will be made along the length of your breast bone. The breast bone will be split lengthwise to expose your heart. You will then be put on a heart-lung machine. This machine takes over the work of your heart so that the doctor can stop your heart.

Your heart will be opened. A substitute valve will be sewn into place. This valve may be mechanical (metal and plastic), such as a St. Jude valve, or it may be made of tissue. Tissue valves most often come from a pig or a cow. Tissue valves may also be supplied by a human donor or even manufactured from your own tissues. When the valve is in place, you will be taken off the heart-lung machine and your heart will be re-started. The incision will be closed.

Mitral Valve Replacement  
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Newer techniques, including robot-assisted procedures, are being developed. These procedures will be able to do the same surgery with smaller incisions.

Immediately After Procedure  

You will be taken to a recovery room. You will be monitored for any negative reactions.

How Long Will It Take?  

About 2-5 hours

How Much Will It Hurt?  

Anesthesia will block pain during the surgery. Your chest and back will be sore following the surgery. Talk to your doctor about medicine to help manage pain.

Average Hospital Stay  

The usual length of stay is 8-10 days. Your doctor may choose to keep you longer if complications arise.

Postoperative Care  

At the Hospital  

You will probably spend 1-3 days in the intensive care unit (ICU) and several more days in a regular hospital room. During this time, your care team will:

  • Observe you for any complications
  • Stabilize your heart function
  • Instruct you in home care and activities

During your stay, the hospital staff will take steps to reduce your chance of infection such as:

  • Washing their hands
  • Wearing gloves or masks
  • Keeping your incisions covered

There are also steps you can take to reduce your chances of infection such as:

  • Washing your hands often and reminding visitors and healthcare providers to do the same
  • Reminding your healthcare providers to wear gloves or masks
  • Not allowing others to touch your incisions

At Home  

Be sure to follow your doctor's instructions, which may include:

  • If you have a mechanical valve, you will need to take blood thinners for life. This will help to prevent blood clots. If you have a tissue valve, you will need to take blood-thinning medicine for six weeks to three months after surgery.
  • You may also need to take antibiotics during dental procedures and during certain other procedures. This will help prevent a valve infection.
  • Ask your doctor about when it is safe to shower, bathe, or soak in water.
  • You will slowly return to your usual activities over a 4-12 week period. You may also be asked to participate in a cardiac rehabilitation program.