Minimally Invasive Mitral Valve Repair

Your heart is like the engine in your body. For this engine to work properly, all the parts inside it need to work properly. The most important parts of the heart are the valves. Just like the doors between the rooms in a house, these valves help blood flow in only one direction. One of these valves is the Mitral Valve. Sometimes, this mitral valve can become defective. In the past, to repair it, you had to open your chest and do a major surgery. But now, because of advanced technology, this surgery can be done through small holes without such a big incision. That's why we call it 'Minimally Invasive Mitral Valve Repair'. We are talking about this today.

Simply put, what is this small incision mitral valve repair?

It's very simple. Think about it, the mitral valve is the door between the upper left chamber (left atrium) and the lower left chamber (left ventricle) of your heart. The job of this door is to let blood flow from the top to the bottom and to close it so that it doesn't flow back up. So if this door doesn't close properly, or doesn't open properly, blood flow is disrupted. That's when this valve needs to be repaired.

'Minimally invasive' means "done with minimal damage." Instead of making an inch-long incision in the middle of the chest like in traditional open-heart surgery, this method involves making one or more small incisions, a few centimeters long, on the side of the chest between the ribs.

Sometimes this is done using robotic surgery. Then the surgeon controls a robotic arm that goes through these tiny holes and very delicately repairs the valve. It's like breaking down a big door and entering a house, and looking through the keyhole and inserting a small wire to fix the lock.

In what cases is this surgery necessary?

This surgery is performed mainly due to two diseases that occur in the mitral valve. Let's look at these two conditions in more detail to understand them more easily.

If the doctor says you have this condition, this surgery may be a good solution.

What is the difference between 'repairing' and 'replacing' a valve?

This is a very important question.

• Repair: What you do here is keep your own valve and fix only the defect in it. It's like fixing a broken chair leg. You don't buy a new chair.
• Replacement: This involves removing your valve completely and replacing it with an artificial valve (mechanical valve) or a valve made from animal tissue (from a pig or cow).

Doctors always try to repair the valve, because there's nothing better than your own natural valve . Once it's repaired, you won't need to take anticoagulants for the rest of your life. But sometimes, if the damage to the valve is so severe that it can't be repaired, it may need to be replaced.

So how do you repair the valve with this small surgery?

The surgeon uses different methods depending on the problem with your valve.

• Annuloplasty: This is the most common procedure. To tighten a leaky valve, a ring of mesh or metal is placed around it and sewn in. This restores the shape of the valve and allows the leaflets to close properly.
• Connecting the valve leaflets: Sometimes the valve leaflets can become weak and droop. Then, those leaflets are strengthened.
• Closing a hole in the valve: If there is a hole in the valve, it is closed.
• Removal of excess tissue: Sometimes, extra tissue can grow in a way that prevents the valve leaflets from closing properly. In this case, the unwanted parts are cut out and removed.
• Separation of stuck valve leaflets: As in the case of stenosis, the leaflets that are stuck together are gently separated and allowed to open properly again.

Who is suitable for this surgery? Can everyone do it?

No. This surgery is not for everyone. Doctors consider several factors to decide whether you are suitable for this or not.

What happens before and during the surgery?

Preparation before surgery

After deciding on surgery for you, your doctor will give you the necessary instructions and will also perform several tests to learn more about your heart.

• Echocardiogram: This is an ultrasound scan of the heart. It can clearly see how the heart's valves are working and how blood is flowing.
• Cardiac Catheterization:This checks for blockages in the arteries that supply blood to the heart (coronary arteries).
• CT Scan: This also produces detailed images of the blood vessels in the heart and chest.

During surgery

These are the things that happen during this surgery, which usually takes between two and four hours.

1. The anesthesiologist will put you under general anesthesia. This means you won't feel anything, you'll be completely asleep.

2. The surgeon will make a small incision about 4-6 centimeters on the right side of your chest, between the ribs.

3. Through this incision, a small tube (endoscope) with a camera attached to it is inserted, and a monitor is used to view your mitral valve in detail.

4. Then, very fine, long surgical instruments are inserted through the incision and the defect in the valve is repaired.

5. After the work is done, the instruments are taken out and the incision is sewn closed.

What happens after the surgery? What are the benefits and risks?

After surgery, you will be kept in the intensive care unit (ICU) for a day or two. During this time, your heart rate and blood pressure will be monitored. You may also have drainage tubes placed in your chest to drain any fluid that may have accumulated.

Then you will be transferred to a regular ward. You will be helped to get up and walk in a day or two. If there is mucus in your lungs, you will be told to do breathing exercises to clear it. You will usually be in the hospital for about five days before you can go home.

How is the recovery time after going home?

You may feel tired as usual for a few weeks after you go home. This is normal. You will gradually regain your strength. Your doctor will advise you when you can return to work and resume your normal activities. You should avoid lifting heavy objects for a few weeks.

Also, your doctor may suggest that you participate in a cardiac rehabilitation program. This is very important. These programs can help you improve your fitness through safe exercise and a healthy diet.

When should you see a doctor after surgery?

If you experience any symptoms of a complication after surgery, you should see your doctor immediately . Be especially aware of the following symptoms.

Finally, sometimes there are even percutaneous interventions to repair these types of valves. This involves passing a tube through a blood vessel in the groin to the heart, and inserting instruments through it to repair the valve. Your doctor will explain which method is best for you.