Mitral Valve Repair

A healthy mitral valve opens wide to allow blood to flow from the left atrium into the left ventricle and closes tightly as blood is pumped out of the left ventricle to prevent any blood from leaking back. Mitral valve disease occurs when the mitral valve is unable to open or close properly, and it includes:

• Mitral stenosis (narrowing), which can slow or block blood flow;
• Mitral regurgitation, in which the mitral valve does not close properly and allows blood to flow backward; and
• Mitral valve prolapse, in which the valve's flaps may be too large and fail to close properly.

Mitral stenosis or narrowing can slow or block blood flow.

At Stony Brook University Hospital, our surgeons perform several kinds of mitral valve repair procedures to restore the proper function of these valves. The traditional mitral valve repair procedure is through open-heart surgery, in which the surgeon opens the chest at the breastbone, stills the patient's heart, and connects the patient to a heart-lung machine, which performs the job of the heart and lungs while the surgeon repairs the valve. Although this method is safe and effective, it is more invasive than the "mini" procedure that we can now offer.

Mitral regurgitation allows blood to flow backward because it does not close properly.

In addition to expertise in open valve surgery, the cardiac surgeons at Stony Brook University Hospital specialize in repairing mitral valves minimally invasively. These procedures feature smaller incisions that are made between the ribs without cutting the breastbone. Smaller incisions tend to result in less trauma, less risk of bleeding, less pain, shorter hospital stays, and quicker recovery times.

How to Prepare

Prior to the procedure, your physician will perform a physical examination and review your medical history. Your physician will give you any specific instructions about dietary or activity restrictions. Be sure to bring a list of any medications and dietary or herbal supplements that you take with you to your doctor's appointment. Tell your doctor if you have any allergies, especially to medication.

Although your physician will give you specific instructions, typically patients may be instructed to stop taking certain medications before surgery. In addition, you may be asked to refrain from eating or drinking after midnight the night before your procedure. Your physician will instruct you about whether you should take your regular medications on the day of the procedure.

What to Expect

You will be taken to the operating room where you will receive anesthesia putting you to sleep, and a breathing tube will then be inserted to help you breathe. You also will be connected to several machines to monitor your vital signs during the procedure.

Mitral valve repair can be performed using:

• Sternotomy, in which the surgeon makes an incision along the breastbone (sternum) and separates it to gain access to the heart and mitral valve; and
• Minimally invasive techniques, in which the surgeon makes 3-inch incision between the ribs to the right of the sternum to gain access to the heart and mitral valve.

There are a number of ways in which your surgeon can repair your mitral valve:

• Commissurotomy, in which valve leaflets (the flaps that open and close to keep blood moving in the right direction) that have become fused together are separated to allow the valve to open and close properly;
• Decalcification, in which the surgeon removes calcium deposits from valve leaflets, allowing them to open and close properly;
• Quadrangular or triangular resection, in which the surgeon removes a portion of a floppy valve leaflet and sews it back together, allowing the valve to close properly;
• Annulus support, in which the surgeon sews a ring around the base of your mitral valve (annulus) that has become too wide to reshape and tighten it; and
• Patched leaflets, in which the surgeon patches tears or holes in valve leaflets to prevent leaking.

Once your surgeon has completed the procedure, he or she will close the heart incision. Your heart is then allowed to resume beating and is disconnected from the heart-lung machine. Depending on the procedure your surgeon uses, mitral valve repair can take from 2 to 4 hours.

Possible Complications

There is a small risk of complications from this procedure that includes (but is not limited to):

• Infection;
• Bleeding;
• Heart Failure;
• Breathing problems;
• Blood clots; and
• Stroke or brain damage.

Recovery

Immediately following your procedure, you will be taken to an intensive care unit. As soon as you are awake and able to breathe on your own, the breathing tube will be removed. The medical staff will monitor your heart, blood pressure, breathing, and other vital signs. You will be walking within 24 hours and may be discharged within a week as long as you experience no complications.

Patients should expect to stay in the hospital for 4 to 7 days, but full recovery can take a few weeks. Before you are discharged from the hospital, you will receive specific instructions about how to care for your incision. Typically, you should keep the incision clean and dry, using only soap and water to clean the area.