Let's learn about Mitral Valve Repair in a simple way.

Do you also experience shortness of breath when you are a little tired, a feeling of faintness when you climb stairs, or a feeling of heaviness in your chest? Sometimes the cause of these symptoms can be a problem with a small opening in our heart, a valve. So today we will talk about the mitral valve in the heart and the repair surgery that may be required due to problems with it.

What is mitral valve repair?

Simply put, mitral valve repair is an open-heart surgery that repairs problems with the mitral valve in your heart.

Think of our heart as a four-chambered house. The mitral valve is the gate between the upper chamber on the left (left atrium) and the lower chamber on the left (left ventricle). The oxygen-rich, clean blood from our lungs first enters the left atrium. Then, that blood enters through the gate called the mitral valve and goes to the left ventricle. From there, blood is pumped to the entire body.

So when this valve, the mitral valve, doesn't work properly, when it becomes diseased, it makes it difficult for the heart to function properly. Over time, this can cause damage to the heart and lungs. This surgery is designed to prevent or delay that damage.

If you have severe mitral valve disease, your doctor will likely recommend surgery to repair or replace the valve. But in many cases, especially if the valve is leaking blood, doctors will try to repair the valve rather than replace it. That's because there are many benefits and fewer risks to preserving a part of your own body.

What conditions does this surgery treat?

This surgery is mainly used to treat the following conditions:

This surgery may be necessary if the left side of your heart is not pumping enough blood to the body (left-sided heart failure) or if your heart is enlarged. However, if the disease is not severe, your doctor can prescribe medication to control your symptoms. However, you should still have regular echocardiograms to monitor the condition of your valve. If the disease progresses or your heart becomes damaged, surgery may be necessary later.

How do you prepare before surgery?

Your doctor and medical team will help you prepare for surgery. It is very important that you follow their instructions exactly.

• You may be asked to stop taking certain medications: You may be asked to stop taking blood thinners (anticoagulants) such as aspirin and warfarin a few weeks before surgery.
• Helps you quit smoking: If you are a smoker, your doctor can help you quit.
• Use an antiseptic soap: You will be told to wash your body with an antiseptic soap the night before surgery.
• Medications to take on the day of surgery: The doctor will tell you what medications to take on the morning of that day.
• Fasting: On the day of surgery, you are advised not to eat or drink anything after a certain time.

What happens during the surgery?

During this surgery, the surgeon will fix one or more problems with your valve. These are the steps that usually occur during the surgery.

1. Anesthesia: You will be given anesthetic drugs to put you in a deep sleep, unconscious.

2. Connection to the heart-lung machine: During the surgery, you will be connected to a special machine (cardiopulmonary bypass machine) that will take over the work of your heart and lungs.

3. Making an incision: An incision is made in the chest. The size of this incision varies depending on the surgical procedure.

4. Annuloplasty ring: A washer-like ring made of fabric is placed around the valve. This provides support to the valve and helps it return to its normal shape.

5. Valve repair: The mitral valve is repaired using one or more different surgical techniques.

6. Inspection: Check that the valve has been repaired properly and make further adjustments if necessary.

7. Weaning: After the surgery, you will be taken off the machine. Then your heart and lungs will start working again.

8. Final check: A special echo test (transesophageal echocardiogram) is performed to confirm whether the valve has been successfully repaired.

What surgical techniques are used for the surgery?

Surgeons use different techniques for this operation. Talk to your doctor about the technique used for your surgery.

Ways to apply cuts

• Full sternotomy: A complete incision is made straight across the middle of the breastbone.
• Partial sternotomy: Cutting only part of the middle breastbone.
• Right thoracotomy: A small incision is made between two ribs on the right side.
• Robotic-assisted method: Surgery performed using a robot using several very small incisions in the ribs.

Other surgical procedures

• Annuloplasty: As we discussed earlier, this involves placing a ring around the valve. This is often done during every mitral valve repair.
• Triangular or quadrangular resection: A small portion of the damaged valve is cut out and removed, and the remaining good parts are stitched together.
• Chordal repair: If the tiny string-like fibers (chordae) that hold the valve in place are damaged, the damaged parts are removed and replaced with artificial ones (made from a material such as Gore-Tex®) or with fibers taken from another healthy part of the heart.

What happens after the surgery?

After surgery, you can expect the following:

• You will need to stay in the intensive care unit (ICU) for a day or two, where the medical team will monitor your pulse and breathing.
• After that, you will have to stay in a regular ward for a few more days.
• I will tell you about cardiac rehab .
• After you go home, you will be instructed on how to care for the surgical wound.

Most people have to stay in the hospital for about a week after this surgery.

What are the benefits of having this surgery?

There are several advantages to repairing an existing valve rather than replacing it with a new one.

• Increased chance of living longer: The chance of living a long and healthy life after surgery increases.
• Optimal protection of heart function: Damage to heart function is minimal.
• Reduced risk of complications: There is a reduced risk of complications such as stroke and endocarditis (infection of the heart valves).
• No need for long-term blood thinners: In most cases, blood thinners (anticoagulants) do not need to be taken for a long time.

How successful is the surgery? What are the possible complications?

This surgery is largely successful. According to reports, even 10 years after the surgery, about 94% of patients do not have significant bleeding.

However, like any surgery, there are some risks and complications that can occur.

• Heartbeat abnormalities (Arrhythmias)
• Bleeding
• Heart block
• Heart failure
• Infection
• Stroke

Talk to your doctor about these risks and how you can reduce them.

How long does it take to recover?

It usually takes about four to eight weeks to fully recover from this surgery, although some people may take longer.

The time it takes for you to recover depends on several factors:

• The severity of your heart disease before surgery: If your heart function was already compromised before surgery, it will take some time to regain strength.
• Your general health before surgery: This depends on whether you were active or had other medical conditions that made it difficult.
• Surgical technique used: If a large incision is made in the middle of the chest (median sternotomy), the bone will take about 6-8 weeks to heal. If surgery is done through smaller incisions, the wounds will heal more quickly.

When should you see a doctor?

It is normal to experience some discomfort after surgery. Your doctor will give you painkillers for this. However, if you experience any of the following symptoms, do not assume that they are normal and contact your doctor immediately.

Sometimes you may not know if this is a normal part of recovery or something serious. If in doubt, it's best to call and ask your doctor.