Our heart is a truly amazing machine, isn't it? The four valves in it work like doors that open only in one direction. One of these important doors is the Mitral Valve. It is this valve that allows clean, oxygen-rich blood to pass from one chamber of the heart to the other. But imagine what happens if something goes wrong with this valve? That is, if the blood does not close properly and leaks backward, or if it does not open properly and becomes blocked, then the heart feels a lot of strain. That is when doctors decide to remove this valve and replace it, if it cannot be repaired.
Simply put, what is mitral valve replacement?
Mitral valve replacement is an open - heart surgery. It involves removing your diseased, malfunctioning mitral valve and replacing it with a brand new valve. This new valve can come in two types.
- Mechanical valves: These are artificial valves made of metals such as carbon and steel.
- Biological/Bioprosthetic valves: These are valves made from heart tissue from pigs, cows, and sometimes (very rarely) human tissue.
Even though this surgery is a major procedure, if your doctor recommends it, it means that your valve is getting worse and could cause serious complications if you don't have the surgery. It also means that it is beyond repair.
Why do you need this surgery?
Oxygen-rich blood from our lungs enters the left atrium of the heart, and from there it passes through the mitral valve to the left ventricle. This left ventricle is responsible for pumping blood throughout the body. Now, if you have mitral valve disease, this valve does not open or close properly. This can cause two major problems.
1. Mitral Valve Regurgitation: Blood leaks backward because the valve does not close properly.
2. Mitral Valve Stenosis: The valve does not open properly, obstructing blood flow.
Both of these factors put a lot of strain on the left side of the heart. Over time, this can damage the heart and lungs.
Surgeons usually try to repair the valve whenever possible, rather than replacing it. However, in some cases, this is not possible.
There may be several reasons why repairs cannot be made:
- Severe damage to the valve due to endocarditis or rheumatic heart disease .
- Extensive calcium deposits or scarring on the valve.
- Severe damage to the papillary muscles or chordae that support the valve.
Therefore, it is very important to discuss your situation with your doctor and learn about your options.
What kind of valve do we choose?
Your age, lifestyle, and other health conditions will play a role in choosing the type of valve you need to have implanted. Let's take a look at the differences between the two types.
| Type of valve | Description and advantages/disadvantages |
|---|---|
| Mechanical Valves |
|
| Biological Valves |
If you are between 50 and 65 years old, your doctor will recommend one of these two types depending on your condition. The most important thing is to talk about this thoroughly and choose the one that suits you best.
How do we prepare before surgery?
Your medical team will give you clear instructions on how to prepare for surgery. In general, you will need to be prepared for these things.
- Some medications (especially blood thinners) that your doctor prescribes may need to be stopped a few weeks before surgery.
- Smoking and tobacco use must be completely stopped.
- The night before surgery, you will be instructed to wash your body with an antiseptic soap .
- The night before surgery, you will have to stop eating and drinking completely, usually after 12 midnight .
- Only take the medications prescribed for the morning of the surgery.
It is also important to set up your home environment so that you can feel comfortable when you return home after surgery. For example, it is a good idea to plan ahead, such as keeping things you will need within reach and arranging for someone to drive you home from the hospital.
What happens during the surgery?
This surgery is a complex procedure that usually takes about two to four hours. But you have nothing to worry about. An experienced medical team will take good care of you. Here is a step-by-step guide to what happens during the surgery.
1. Anesthesia: First, you will be put completely to sleep. So you will not feel anything about the surgery and will not remember it when you wake up.
2. Connections: You will be connected to monitors to monitor your heart rate and breathing. You will be given antibiotics through a vein to prevent infection.
3. Cardiopulmonary Bypass Machine: Next, you will be connected to a special machine. This machine temporarily takes over the work of your heart and lungs during the surgery. Your heart will not beat during this time.
4. Incision: The surgeon will make an incision in your chest to access the heart. This is often done through a sternotomy (cut along the middle of the breastbone).
5. Valve replacement: An incision is made in the left atrium of the heart to reach the mitral valve. Then, the damaged parts of the valve are carefully removed, and the new valve is placed in its place and sewn tightly.
6. Testing: Check to see if the new valve is working properly and if its doors open and close properly.
7. End of surgery: Once everything is OK, the incision in your heart will be closed and you will be slowly removed from the heart-lung machine.
What are the benefits and risks of this surgery?
Like any surgery, there are benefits and risks, and it's important to be aware of these.
| Benefits | Risks/Complications |
|---|---|
|
Don't be afraid of these risks. Your medical team is highly trained to reduce the likelihood of these conditions occurring and to manage them if they occur.
What happens after the surgery? How long does it take to recover?
After the surgery, you will usually have to stay in the hospital for about a week.
- For the first day or two, you will be kept in the intensive care unit (ICU) and your condition will be monitored very closely.
- Then you will be transferred to a regular ward.
- It is common to have irregular heartbeats after surgery, and you may need medication or even a temporary pacemaker for this.
- Blood thinners will be started to reduce the risk of blood clots.
- You will be informed about a cardiac rehabilitation program that will help you recover quickly.
It usually takes between 4 and 8 weeks to fully recover. However, this time varies from person to person. This is affected by factors such as your pre-surgery health and the severity of your condition.
The most important thing is not to rush your recovery. Not everyone is the same. Give your body the time it needs to heal, and accept help from others.
Your doctor will tell you when you can resume activities like driving and lifting weights. It's also important to make eating a heart-healthy diet, avoiding smoking and alcohol, maintaining a healthy weight, and continuing to exercise part of your lifestyle.
What are the symptoms that require immediate attention?
It is very important to take care of your body during your recovery. If you experience any of the following symptoms, call your doctor immediately or go to the Emergency Department (ETU) of your nearest hospital.
| Danger symptoms - seek medical advice immediately! | |
|---|---|
| - Chest pain | - Severe headache |
| - Signs of infection such as fever, chills, and pus draining from the cut | - Irregular heartbeat (too fast or too slow ) |
| - Cough with yellow or green mucus | - Pain, redness, or swelling in the lower leg |
| - Dizziness or lightheadedness | - Difficulty breathing |
| - Symptoms of a stroke such as difficulty speaking, slurred speech | - Nausea and vomiting |
Don't ignore it, thinking, "This might be something minor." Even a symptom that seems minor could be a sign of something serious. So if you have any doubts, don't hesitate to talk to your doctor.
Take-Home Message
- Mitral valve replacement surgery is a major life-saving surgery that is now widely performed, so don't be unnecessarily afraid of it.
- Choosing the right type of valve for you, whether mechanical or biological, depends on your age and lifestyle. Discuss this with your doctor before making a decision.
- It takes time to fully recover from surgery. Listen to your body and be patient.
- Taking your doctor's prescribed medications (especially blood thinners) on time and adopting a healthy lifestyle are essential for your long-term well-being.
- Always be aware of danger signs. If in doubt, seek medical advice immediately.
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