What is the Mitral Valve Replacement Surgery?

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What is the meaning of Mitral Valve Replacement Surgery?

A surgical procedure performed to replace a leaky or stiff mitral valve in the heart with an artificial valve is known as mitral valve replacement surgery. The mitral valve is one of the four valves that are present in the heart. It is situated between the left atrium and the left ventricle (upper and lower left chambers) of the heart. The mitral valve helps the blood in flowing through the heart and out into the body. The mitral valve replacement surgery helps the blood to flow into the left ventricle of the heart, and later flow out to the body normally, without adding any extra pressure on the heart.

In this article, we will be discussing in detail about mitral valve replacement surgery.

• What are the different types of Mitral Valve Replacements?
• What is the purpose of Mitral Valve Replacement Surgery?
• What are the symptoms that indicate the need for a Mitral Valve Replacement Surgery?
• What is the diagnostic procedure before a Mitral Valve Replacement Surgery?
• How to prepare for Mitral Valve Replacement Surgery?
• What is the procedure for Mitral Valve Replacement Surgery?
• How to care after Mitral Valve Replacement Surgery?
• What are the risks of Mitral Valve Replacement Surgery?
• What is the cost of Mitral Valve Replacement Surgery in India?

What are the different types of Mitral Valve Replacements?

The mitral valve can be replaced with the following different types of valves:

Biological valves:

• These types of valves are made from pig, cow, or human heart tissue.
• They do not last as long as mechanical valves.

Mechanical valves:

• These types of valves are synthetic, man-made valves that are made of materials like carbon and titanium.
• The doctor prescribes blood-thinning medications to be taken for the rest of the life after mechanical valve placement.
• The mechanical valves last longer than biological valves but may lead to an increased risk of infection.

What is the purpose of Mitral Valve Replacement Surgery?

A mitral valve replacement surgery is done in the following conditions:

Mitral valve stenosis:

• When the mitral valve cannot open completely it can result in stenosis.
• This leads to less blood flow from the left atrium into the left ventricle.

Mitral valve regurgitation:

• Regurgitation is a leaky mitral valve.
• In this condition, some blood leaks back into the left atrium instead of moving forward into the left ventricle.

Ischemic heart disease or coronary artery disease:

• Plaque accumulation in the blood vessels that supply blood to the heart may cause this condition.
• This leads to a decreased blood flow to the heart.

Infectious endocarditis:

• Heart valve infection leads to infective endocarditis.
• It is commonly seen in people having artificial or damaged heart valves.

Heart failure:

• When the heart fails to pump sufficient blood to the rest of the body it causes heart failure.
• This leads to an insufficient supply of oxygen and blood to the rest of the body. ( Know more about- What are the symptoms of Heart Attack ? )

Rheumatic fever:

• A streptococcal bacterial infection causing inflammation and infection of the heart valves, blood vessels, and joints is known as rheumatic fever.
• This causes mitral valve scarring and stenosis.

Mitral Valve prolapse that cannot be treated using medications:

• When the mitral valve bulges back into the upper left atrium while there is a contraction of the heart muscles to supply blood is known as mitral valve prolapse.
• This condition can be heard as a heart murmur using a stethoscope.
• When this condition cannot be treated using medications, a mitral valve surgery will be needed to correct the damaged mitral valve.

What are the symptoms that indicate the need for a Mitral Valve Replacement Surgery?

The different symptoms associated with mitral valve disorders, which  could indicate the need for a mitral valve replacement surgery are:

• Breathlessness 
• Difficulty in breathing
• Fatigue
• Dizziness  ( Know more about- What is Dizziness ? )
• Irregular heartbeat (arrhythmia)
• Palpitations (skipped or extra heartbeats)
• Fluid retention
• Rapid weight gain
• Chest pain ( Know more about- Home remedies for Chest Pain )
• Swelling of the ankles, feet, or stomach

What is the diagnostic procedure before a Mitral Valve Replacement Surgery?

The following diagnostic tests may be performed before a mitral valve replacement surgery:

• Physical examination: A clicking sound heard by the doctor using a stethoscope indicates a mitral valve prolapse, while a heart murmur indicates the leaking of blood back into the left atrium. The patient’s symptoms, medical history, and family history are also noted.
• Echocardiogram: This test involves the use of high-frequency sound waves to create clear images of the heart. 
• Transesophageal echocardiogram: A flexible device with a small device, called a transducer, is attached to the throat and passed down the esophagus (food pipe) to obtain clear pictures of the mitral valve and heart.
• Chest x-ray: The condition of the lungs, heart, and blood vessels in the chest region is evaluated using a chest x-ray.
• Electrocardiogram (ECG): The electrical activity of the heart can be measured using this test. ( Know more about- What is Echocardiography ? )
• Stress test: The ability of the body to exercise is limited in the case of mitral valve regurgitation. The doctor evaluates the patient while performing certain physical exercises.
• Coronary angiogram: This test involves the use of an x-ray to see the heart’s blood vessels. It helps the doctor to determine the severity of the condition.

How to prepare for Mitral Valve Replacement Surgery?

The following preparation may be done before a mitral valve replacement surgery:

• Tell the doctor if the patient has any underlying medical diseases.
• Tell the doctor if the patient is taking any herbs, supplements, or medications.
• If the patient has any known allergies, inform the doctor about the same.
• The patient is instructed to quit smoking at least two weeks prior to the surgery.
• The patient is told to avoid eating or drinking anything after midnight, the day before the surgery.
• The doctor recommends stopping blood-thinning medications like aspirin and warfarin a few days before the procedure.

What is the procedure for Mitral Valve Replacement Surgery?

The mitral valve replacement surgery is usually done under general anesthesia (the patient is put to sleep before the procedure), and can be performed in the following ways:

Open mitral valve replacement surgery:

• An incision or cut is made down the middle of the chest.
• The breastbone is then separated to access the heart.
• The heart’s function is stopped.
• Meanwhile, the patient is attached to a heart-lung bypass machine. This machine performs the function of the heart and lungs during the surgery.
• The surgeon now removes the damaged mitral heart valve and replaces it with an artificial new valve.
• The heart-lung machine is now removed.
• The breastbone is now wired back together.
• The incision is stapled or sutured back together.( Know more about- What is heart bypass surgery? )

Minimally invasive mitral valve surgery:

• A 2 to 3-inch long incision is made along the chest near the breastbone. 
• The muscles in this chest area are separated to reach the heart.
• A small incision is now made on the left side of the heart and the mitral valve is replaced.

Endoscopic surgery:

• The procedure is performed by making one to four small holes in the chest region.
• Mitral valve surgery is performed by using the endoscope with a camera on one end to view the inside and other small surgical tools inserted through these holes.

Robotically-assisted mitral valve surgery:

• 2 to 4 tiny incisions, approximately 1.5 to 2 centimeters in size, are made in the chest area.
• The surgery is performed in a manner similar to endoscopic surgery, but by robotic arms.
• The surgeon controls the arms of the robot during the surgery by viewing the monitor.

Transcatheter procedure:

• This procedure involves inserting a catheter (tube) in a vein in the leg or groin region.
• This catheter is now guided to the heart and can be used to deliver surgical tools for replacing the valve. ( Know more about- What is TAVI? )

How to care after Mitral Valve Replacement Surgery?

The following are the post-procedure steps after a mitral valve replacement surgery:

• The patient spends a day or two in the intensive care unit (ICU) after the surgery.
• The patient is then moved to a regular hospital room from the ICU. 
• The patient stays usually stays in the hospital for 3 to 5 days following surgery.
• It is normal to feel pain and fatigue for a couple of weeks after the surgery. These symptoms usually subside within 4 to 6 weeks.
• Two or three drainage tubes are placed in the chest t region to drain out the fluid accumulated in the heart. These drainage tubes are usually removed one to three days after the surgery.
• Stitches are usually removed by the surgeon 7 to 10 days after the procedure.
• If the heart rate of the patient goes down drastically after the surgery, the surgeon may place a temporary or permanent pacemaker in the patient.
• The patient should maintain proper hygiene after going home to prevent infection.
• The medications recommended by the doctor should be taken regularly.
• Strenuous physical activity and heavy lifting should be avoided for a few weeks after the surgery.
• The patient can resume his/her daily activities only after the doctor permits.
• The doctor should be immediately contacted if the patient has a fever or notices a drastic change in weight after the surgery.
• Regular follow-up appointments with the doctor are recommended after the procedure.

What are the risks of Mitral Valve Replacement Surgery?

The various complications associated with a mitral valve replacement surgery are:

• Bleeding
• Infection
• Blood clot formation
• Allergic reactions to the anesthesia uses
• Irregular heart rhythms 
• Replaced mitral valve continues to leak
• Damage to the nearby organs
• Improper functioning of the replaced valve
• Memory loss ( Know more about- What is Memory Loss ? )
• Concentration problems
• Stroke (a condition in which the blood flow to the brain is interrupted)
• Death

What is the cost of Mitral Valve Replacement Surgery in India?

The total cost of mitral valve replacement surgery in India can range from around INR 3,25,000 to INR 5,25,000. However, there are many large hospitals and experienced doctors in India who perform mitral valve replacement surgery. But the cost of mitral valve replacement surgery may vary across different hospitals.

If you are coming from abroad, apart from the cost of mitral valve replacement surgery, there will be a cost of staying in a hotel, cost of living, and cost of local travel. Apart from this, after the procedure, the patient stays in the hospital for 5 days and in the hotel for 10 days for recovery. So, the total cost of mitral valve replacement surgery will be around INR 4,90,000 to  INR 6,00,000.

We hope that we could answer your questions regarding mitral valve replacement surgery through this article.

If you need more information about mitral valve replacement surgery, you can contact a Cardiovascular and Thoracic Surgeon.

We only aim to give you information through this article and do not recommend medication or treatment in any way. Only a qualified doctor can give you good advice and a treatment plan.