It's normal to feel a little scared and nervous when your doctor tells you about heart surgery, especially a mitral valve repair. "What is this surgery?", "Why do I need to do this?", "Is it dangerous?", etc. Many questions probably come to mind. Today, we'll talk about all of this in a very simple way that you can understand.
What is this mitral valve? What does it mean to repair it?
Think of your heart as a four-chambered house. The "door" on the left side of the heart between the upper chamber (left atrium) and the lower chamber (left ventricle) is called the Mitral Valve . This door opens to allow oxygen-rich blood from the lungs to enter the left ventricle. The left ventricle then pumps the blood to the rest of the body.
So the problems start when this valve, the mitral valve, doesn't work properly. Over time, this can damage the heart and lungs. Mitral valve repair involves open-heart surgery to repair the defect in this valve. Doctors always try to repair your own valve rather than replace it completely. This is because it has more benefits and fewer risks.
In what conditions is this surgery necessary?
The doctor may consider this surgery in three main medical conditions.
| Medical condition | Simply put... |
|---|---|
| Mitral Valve Regurgitation | The two flaps of the valve do not close properly, causing blood to "leak" in the wrong direction, that is, backward. If this leak is large or there are symptoms, surgery may be necessary. |
| Mitral Valve Stenosis | The opening of the valve becomes blocked and narrowed, preventing enough blood from flowing through it. If this is severe, the doctor will first try other treatments (e.g., balloon mitral valvotomy) and, if that doesn't work, will refer you to surgery. |
| Mitral Valve Prolapse | The two leaflets of the valve become too loose and droopy. This can also cause blood to leak backward. Only 60% of mitral valve surgeries are performed because of this condition. |
If the left side of your heart (left ventricle) has reduced blood flow to your body (left-sided heart failure) or if your heart is enlarged, this surgery may also be necessary. However, if the disease is in its early stages, it may be controlled with medication. Your doctor will often perform an echocardiogram to monitor your heart condition.
How do you prepare before surgery?
It is very important to follow the instructions your medical team gives you before surgery. They may tell you things like:
- You will be asked to stop taking certain medications, especially anticoagulants (e.g., aspirin, warfarin), a few weeks before surgery.
- If you smoke, it will help you quit .
- The night before the surgery, you will be asked to wash your body with an antiseptic soap.
- They will tell you what medications you need to take the morning of the surgery.
- You will be asked to stop eating and drinking after a certain time on the day of surgery.
What actually happens during surgery?
Since this is open-heart surgery, you will be given anesthesia and put to sleep. So you won't feel anything. Here's what happens during the surgery, simply:
1. Anesthesia: This puts you in a deep sleep, without feeling any pain.
2. Bypass machine: During surgery, you will be connected to a special machine called ``Cardiopulmonary Bypass Machine'' to temporarily do the work of your heart and lungs.
3. Incision: The surgeon makes an incision in the chest. The size of this incision varies depending on the type of surgery being performed.
4. Valve repair: The surgeon then uses various techniques to repair the defect in your mitral valve. Often, a ring made of fabric (annuloplasty ring) is placed around the valve to support it. This restores the valve to its normal position.
5. Inspection: The valve is checked to make sure it has been properly repaired. Further adjustments are made if necessary.
6. Resuscitation: You are disconnected from the bypass machine and your heart and lungs are made to work again.
7. Final examination: A special test called a Transesophageal Echocardiogram is used to look at the valve and confirm whether the surgery was successful.
What are the techniques used for the surgery?
Surgeons use different methods for this. For example, even the incision in the chest may be different.
- A large incision down the middle of the chest (Full Sternotomy)
- Partial sternotomy (small incision in part of the chest)
- A small incision made between two ribs (Right Thoracotomy)
- Robotic surgery is performed by making several very small incisions between the ribs.
There are various ways to repair the valve. These include cutting out the damaged parts and stitching the remaining parts, or replacing the chordae with special synthetic threads such as Gore-Tex® if the chordae are loose. Your doctor will explain this to you in more detail.
What happens after the surgery? How long does it take to recover?
After the surgery, you will need to stay in the intensive care unit (ICU) for a day or two. There, the medical team will closely monitor your pulse and breathing. After that, you will be in a regular ward for a few more days before you can go home. It takes about four to eight weeks to fully recover. Some people may take longer.
Remember this very important thing: Your recovery journey is unique to you. While your neighbor may be completely healed in a month, it may take you several months. That's normal. So don't compare yourself to others. Don't put pressure on yourself to get well quickly.
There are several factors that affect the speed of your recovery:
- The severity of your heart disease before surgery.
- Your overall health before surgery.
- The surgical technique used for the surgery.
After you go home, set small goals and gradually get back to your normal activities. Get plenty of rest. Your doctor will tell you when you can start driving, lifting weights, and exercising.
What are the benefits of renovation? Are there any risks?
There are several advantages to repairing a valve over replacing it.
- Increased chances of survival and long-term survival after surgery.
- Better protection of heart function.
- Reduced risk of complications such as stroke and endocarditis.
- No need to take anticoagulants for the rest of your life.
Like all surgeries, there are risks. For example, abnormal heart rhythms (arrhythmias), bleeding, and infection can occur. But your doctor is recommending this surgery because they believe the benefits of the surgery far outweigh the risks . It is reported that 94% of people who have this surgery will not have any major valve problems again 10 years after the surgery. This means that it is a very successful and long-lasting solution.
When should I see a doctor after surgery?
It is normal to experience some discomfort during the recovery period. However, if you experience one or more of the following symptoms, it could be a sign of a complication. In such a case, call your doctor or go to the hospital immediately.
| Warning signs to look out for | |
|---|---|
| • Chest pain | • Fever or chills |
| • Cough with yellow or green mucus | • Dizziness or lightheadedness |
| • Swelling, redness, and pus around the surgical incision | • Difficulty breathing |
| • Abnormal pulse (too fast or too slow ) | • Slurred speech or other signs of a stroke |
| • Nausea and vomiting | • Pain, redness, or swelling in the lower leg |
If you have any concerns about a symptom, never be afraid to ask your doctor about it. It's comforting to know that it's not something serious.
Take-Home Message
- Mitral valve repair is a surgical procedure to repair a defect in your own heart valve. This is often a better option than replacing the valve.
- It can take 4-8 weeks or longer to fully recover from this surgery. Don't compare your recovery journey to others.
- Follow the doctor's instructions carefully before and after surgery. It is very important for your recovery.
- Be aware of warning signs such as chest pain, difficulty breathing, fever, and signs of infection in the incision. If in doubt, seek medical advice immediately.
- This surgery is a very successful, long-lasting solution. Feel free to discuss any questions, concerns, or doubts you have about this with your doctor.
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