Mitral Valve Surgery

Mitral valve replacement surgery is a procedure done to replace a stiff or leaky mitral valve in the heart. The mitral valve is one of the four valves present in the heart, which is located between the left chambers of the heart, that is, the left atrium and the left ventricle of the heart. It helps the blood to flow through the heart and out into the body. The surgeon will replace your poorly working mitral valve with an artificial valve in this procedure. The procedure ensures that the blood can flow into the left ventricle of the heart, and then flow out to the body normally, without any extra pressure on the heart.

Types of Mitral Valve Replacements:
The surgeon can replace the mitral valve with two different types of replacement valves:
1.Biological valves:
These valves are mostly made from cow, pig, or human heart tissue. These valves do not last as long as the mechanical valves.

2. Mechanical valves:
These are man-made, synthetic valves made of materials like titanium and carbon. If you receive a mechanical valve, the doctor will prescribe blood-thinning medications to be taken for the rest of your life. These valves last longer than biological valves, but they cause an increased risk of infection.

Know More About Surgery

Purpose: A mitral valve replacement surgery is required in the following cases:
1. Mitral valve stenosis:
A condition that occurs when the mitral valve is not able to open completely. Therefore, less blood can flow from the left atrium into the left ventricle.

2. Mitral valve regurgitation:
This condition occurs due to a leaky mitral valve. Some blood tends to leak back into the left atrium, instead of going ahead into the left ventricle.

3. Coronary artery disease or ischemic heart disease:
This condition occurs due to the accumulation of plaque in the blood vessels that supply blood to the heart. This decreases the blood flow to the heart.

4. Infectious endocarditis:
This condition is seen due to an infection of the heart valves. It is commonly seen in people with damaged or artificial heart valves.

5. Heart failure:
When the heart cannot pump sufficient blood to the body, it leads to a condition known as heart failure. It causes an insufficient supply of blood and oxygen to the body.

6. Rheumatic fever:
A streptococcal bacterial infection that leads to the infection and inflammation of the valves of the heart, blood vessels, and joints is called rheumatic fever. This leads to mitral valve scarring and stenosis.

7. Mitral Valve prolapse that cannot be treated using medicines:
Mitral valve prolapse is a condition that occurs when the mitral valve bulges back into the upper left chamber of the heart while the heart muscles are contracting to supply blood. This can be heard as a heart murmur in the stethoscope by a doctor. In certain cases, this condition can not be treated with medications, and mitral valve surgery will be required to correct the damaged mitral valve.

Symptoms of Mitral Valve Diseases:The various symptoms associated with mitral valve disorders, which may indicate the need for a mitral valve replacement surgery:

  • Breathlessness or difficulties in breathing

  • Dizziness

  • Fatigue

  • Arrhythmia (irregular heartbeat)

  • Palpitations (noticeable heartbeats)

  • Chest pain

  • Swelling or edema of the ankles, feet, or abdomen (stomach)

  • Fluid retention causing quick weight gain

  1. Physical examination: The doctor will listen to your heart using a stethoscope. A clicking sound may indicate a mitral valve prolapse, while a heart murmur can indicate leaking of blood back into the left atrium.

  2. Echocardiogram: This is a non-invasive ultrasound test for the heart. High-frequency sound waves are used to create clear images of the heart. It can help the doctor to view the blood flow through the mitral valve and measure the amount of regurgitation or leakage of blood.

  3. Transesophageal echocardiogram: A flexible device with a small device, known as a transducer, is attached to the throat and down the esophagus (food pipe) to obtain clear images of the mitral valve and the heart.

  4. Chest x-ray: This x-ray helps in obtaining a picture of the lungs, heart, and blood vessels.

  5. Electrocardiogram (ECG): This is a non-invasive test done to record the electrical activity of the heart. It helps in detecting the irregularities in your heart.

  6. Stress test: A mitral valve regurgitation limits the ability to exercise. The doctor may recommend certain exercises or medications to increase the heart rate and make the heart work harder during the test.

  7. Coronary angiogram: This test uses an x-ray to see the blood vessels of the heart. It helps the doctor in determining the severity of the condition.

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

1. Open mitral valve replacement surgery:

  • The doctor will make an incision down the middle of the chest.
  • The surgeon will separate the breastbone to access the heart.
  • The doctor will attach you to a heart-lung or bypass machine. This machine performs the function of the heart and lungs during the procedure.
  • The surgeon will remove the damaged mitral heart valve and then replace it with a new valve.
  • The heart-lung machine is then removed.
  • The surgeon will wire the breastbone back together.
  • The surgeon will then staple or stitch (suture) the incision in the skin back together.

2. Minimally invasive mitral valve surgery:

  • The surgeon will give a 2 to 3-inch incision along the chest near the breastbone. 
  • The muscles in this area are then separated to reach the heart.
  • A small incision or cut is then made on the left side of the heart for replacing the mitral valve.

3. Endoscopic surgery:

  • The surgeon makes one to four small holes in the chest region.
  • The surgeon then performs mitral valve surgery by using the camera on the endoscope and special surgical tools that can be inserted through these holes.

4. Robotically-assisted mitral valve surgery:

  • This kind of surgery is performed by making 2 to 4 tiny cuts in the chest region. These incisions are approximately 1.5 to 2 centimeters in size.
  • A special computer is used by the surgeon to control the arms of the robot during the surgery.
  • The surgeon can view the complete 3D view of the mitral valve and heart on a computer monitor in the operating room.

5. Transcatheter procedure:

  • This procedure involves the insertion of a catheter in a vein.
  • This catheter is guided to the heart and may be used for delivering tools for the replacement of the valve.

The risks associated with mitral valve replacement surgery include:

  • Bleeding

  • Infection

  • Blood clot formation

  • Irregular heart rhythms

  • Allergic reactions to anesthesia

  • Continuation of the leakage of the valve

  • Damage to the organs nearby

  • Dysfunction of the replacement valve

  • Loss of memory

  • Problems in concentrating

  • Stroke (blood flow to the brain stops)

  • Death

  • You will be spending a day or two in the intensive care unit (ICU) following the surgery.

  • You will then be moved to a regular hospital room from the ICU. 

  • You will stay in the hospital for 3 to 5 days after the procedure.

  • It is normal to feel tired and sore for a few weeks after the surgery. The symptoms usually improve after 4 to 6 weeks.

  • Two or three tubes are placed in the chest to drain out the fluid from the heart. These tubes are removed one to three days after the surgery.

  • Stitches or sutures are removed by the surgeon 7 to 10 days after the procedure.

  • A temporary or permanent pacemaker may be placed by the surgeon in the patient’s heart after the surgery if the heart rate falls down too much after the surgery.

  • Proper hygiene should be maintained after going home to prevent infection.

  • The medications prescribed by the doctor should be taken regularly.

  • Strenuous physical activity should be avoided after the surgery.

  • Resume your daily activities only after the doctor permits you for the same.

  • Contact your doctor if you have a fever or notice a drastic change in weight after the procedure.

  • Regular follow-up appointments with your doctor are recommended after the surgery.

Mitral Valve Surgery Cost in Bengaluru

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Mitral Valve Surgery

Mitral valve replacement surgery is a procedure done to replace a stiff or leaky mitral valve in the heart. The mitral valve is one of the four valves present in the heart, which is located between the left chambers of the heart, that is, the left atrium and the left ventricle of the heart. It helps the blood to flow through the heart and out into the body. The surgeon will replace your poorly working mitral valve with an artificial valve in this procedure. The procedure ensures that the blood can flow into the left ventricle of the heart, and then flow out to the body normally, without any extra pressure on the heart.

Types of Mitral Valve Replacements:
The surgeon can replace the mitral valve with two different types of replacement valves:
1.Biological valves:
These valves are mostly made from cow, pig, or human heart tissue. These valves do not last as long as the mechanical valves.

2. Mechanical valves:
These are man-made, synthetic valves made of materials like titanium and carbon. If you receive a mechanical valve, the doctor will prescribe blood-thinning medications to be taken for the rest of your life. These valves last longer than biological valves, but they cause an increased risk of infection.

Symptoms

Purpose: A mitral valve replacement surgery is required in the following cases:
1. Mitral valve stenosis:
A condition that occurs when the mitral valve is not able to open completely. Therefore, less blood can flow from the left atrium into the left ventricle.

2. Mitral valve regurgitation:
This condition occurs due to a leaky mitral valve. Some blood tends to leak back into the left atrium, instead of going ahead into the left ventricle.

3. Coronary artery disease or ischemic heart disease:
This condition occurs due to the accumulation of plaque in the blood vessels that supply blood to the heart. This decreases the blood flow to the heart.

4. Infectious endocarditis:
This condition is seen due to an infection of the heart valves. It is commonly seen in people with damaged or artificial heart valves.

5. Heart failure:
When the heart cannot pump sufficient blood to the body, it leads to a condition known as heart failure. It causes an insufficient supply of blood and oxygen to the body.

6. Rheumatic fever:
A streptococcal bacterial infection that leads to the infection and inflammation of the valves of the heart, blood vessels, and joints is called rheumatic fever. This leads to mitral valve scarring and stenosis.

7. Mitral Valve prolapse that cannot be treated using medicines:
Mitral valve prolapse is a condition that occurs when the mitral valve bulges back into the upper left chamber of the heart while the heart muscles are contracting to supply blood. This can be heard as a heart murmur in the stethoscope by a doctor. In certain cases, this condition can not be treated with medications, and mitral valve surgery will be required to correct the damaged mitral valve.

Symptoms of Mitral Valve Diseases:The various symptoms associated with mitral valve disorders, which may indicate the need for a mitral valve replacement surgery:

  • Breathlessness or difficulties in breathing

  • Dizziness

  • Fatigue

  • Arrhythmia (irregular heartbeat)

  • Palpitations (noticeable heartbeats)

  • Chest pain

  • Swelling or edema of the ankles, feet, or abdomen (stomach)

  • Fluid retention causing quick weight gain

Diagnosis

  1. Physical examination: The doctor will listen to your heart using a stethoscope. A clicking sound may indicate a mitral valve prolapse, while a heart murmur can indicate leaking of blood back into the left atrium.

  2. Echocardiogram: This is a non-invasive ultrasound test for the heart. High-frequency sound waves are used to create clear images of the heart. It can help the doctor to view the blood flow through the mitral valve and measure the amount of regurgitation or leakage of blood.

  3. Transesophageal echocardiogram: A flexible device with a small device, known as a transducer, is attached to the throat and down the esophagus (food pipe) to obtain clear images of the mitral valve and the heart.

  4. Chest x-ray: This x-ray helps in obtaining a picture of the lungs, heart, and blood vessels.

  5. Electrocardiogram (ECG): This is a non-invasive test done to record the electrical activity of the heart. It helps in detecting the irregularities in your heart.

  6. Stress test: A mitral valve regurgitation limits the ability to exercise. The doctor may recommend certain exercises or medications to increase the heart rate and make the heart work harder during the test.

  7. Coronary angiogram: This test uses an x-ray to see the blood vessels of the heart. It helps the doctor in determining the severity of the condition.

Treatment

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

1. Open mitral valve replacement surgery:

  • The doctor will make an incision down the middle of the chest.
  • The surgeon will separate the breastbone to access the heart.
  • The doctor will attach you to a heart-lung or bypass machine. This machine performs the function of the heart and lungs during the procedure.
  • The surgeon will remove the damaged mitral heart valve and then replace it with a new valve.
  • The heart-lung machine is then removed.
  • The surgeon will wire the breastbone back together.
  • The surgeon will then staple or stitch (suture) the incision in the skin back together.

2. Minimally invasive mitral valve surgery:

  • The surgeon will give a 2 to 3-inch incision along the chest near the breastbone. 
  • The muscles in this area are then separated to reach the heart.
  • A small incision or cut is then made on the left side of the heart for replacing the mitral valve.

3. Endoscopic surgery:

  • The surgeon makes one to four small holes in the chest region.
  • The surgeon then performs mitral valve surgery by using the camera on the endoscope and special surgical tools that can be inserted through these holes.

4. Robotically-assisted mitral valve surgery:

  • This kind of surgery is performed by making 2 to 4 tiny cuts in the chest region. These incisions are approximately 1.5 to 2 centimeters in size.
  • A special computer is used by the surgeon to control the arms of the robot during the surgery.
  • The surgeon can view the complete 3D view of the mitral valve and heart on a computer monitor in the operating room.

5. Transcatheter procedure:

  • This procedure involves the insertion of a catheter in a vein.
  • This catheter is guided to the heart and may be used for delivering tools for the replacement of the valve.

Risks

The risks associated with mitral valve replacement surgery include:

  • Bleeding

  • Infection

  • Blood clot formation

  • Irregular heart rhythms

  • Allergic reactions to anesthesia

  • Continuation of the leakage of the valve

  • Damage to the organs nearby

  • Dysfunction of the replacement valve

  • Loss of memory

  • Problems in concentrating

  • Stroke (blood flow to the brain stops)

  • Death

After Procedure

  • You will be spending a day or two in the intensive care unit (ICU) following the surgery.

  • You will then be moved to a regular hospital room from the ICU. 

  • You will stay in the hospital for 3 to 5 days after the procedure.

  • It is normal to feel tired and sore for a few weeks after the surgery. The symptoms usually improve after 4 to 6 weeks.

  • Two or three tubes are placed in the chest to drain out the fluid from the heart. These tubes are removed one to three days after the surgery.

  • Stitches or sutures are removed by the surgeon 7 to 10 days after the procedure.

  • A temporary or permanent pacemaker may be placed by the surgeon in the patient’s heart after the surgery if the heart rate falls down too much after the surgery.

  • Proper hygiene should be maintained after going home to prevent infection.

  • The medications prescribed by the doctor should be taken regularly.

  • Strenuous physical activity should be avoided after the surgery.

  • Resume your daily activities only after the doctor permits you for the same.

  • Contact your doctor if you have a fever or notice a drastic change in weight after the procedure.

  • Regular follow-up appointments with your doctor are recommended after the surgery.

FAQ Section

1) How serious is a leaky heart valve?

A leaky heart valve is a condition when the valves which normally perform the function of preventing the back- flow of blood, becomes leaky. Due to this, some of the blood pumped by the heart will leak backwards, known as regurgitation. This condition may go unnoticed. The damage caused due to this condition is dependent on the extent with which it interferes with the rate of blood flow through the heart. It can cause diseases which may be severe or minor and can be dangerous if untreated after it has become severe.

2) What is the survival rate for heart valve replacement surgery?

Heart valve replacement surgery is performed either to replace or repair a leaky valve. This procedure has a good success rate, and according to recent studies, the five-year survival rate of this procedure is 91%. The life expectancy of this procedure is varies with age. However, on an average, the life expectancy of a 60- year- old is about 12 years after the surgery has been performed.

3) How long does a Mitral valve repair last?

A Mitral Valve Repair is usually an open-surgery and may take around two to four hours to be performed. A minimally invasive heart valve replacement may last for a shorter duration with a shorter recovery period.

4) How long is recovery for Mitral valve repair?

After Mitral Valve Repair, your doctor may suggest you to remain in the hospital for a few days, including a day or two in the Intensive Care Unit for close observation of any further complications. The duration of recovery may take a long time, and is highly dependent on the health conditions of the patient prior to the surgery. On an average, the recovery time lasts around four to eight weeks.

5) Is Mitral valve replacement surgery dangerous?

Just like any other surgery, Mitral Valve Replacement comes with its own set of risks and complications. The severity of these risks depends upon the condition of the patient. Some of the possible complications include bleeding, blood clots, infections etc. And some rare severe conditions may even lead to death. However, the risk factor associated with this procedure is quite low due to its high success rate.

6) What is Mitral Valve Replacement?

Mitral Valve is the valve located between the left chambers of the heart, i.e. the left auricle and the left ventricle, which regulates the uni-directional flow of blood in the body. Mitral Valve Replacement is a cardiac surgical procedure performed for the treatment of diseases affecting the mitral valve. It is sometimes combined with a surgery to treat any other heart condition other than mitral valve disease. Your cardiologist will recommend this procedure upon diagnosis of the disease. It involves the replacement or repair of a diseased valve with a mechanical valve or a bio-prosthetic valve made up of cow, pig or human heart tissue.

7) Why does one need to perform Mitral Valve Replacement?

This procedure is usually performed for the treatment of mainly two conditions affecting the Mitral Valve. The first is mitral valve regurgitation, in which the flaps of the leaves do not close tightly enough to prevent the backflow of blood into the left atrium. In the other condition, known as mitral valve stenosis, the flaps of the leaves become stiff or tight, due to which they tend to stick together, resulting in narrowing of the valve and reduced blood flow.

8) What are the risk factors of Mitral Valve Replacement?

Though it is a minor surgical procedure, it is associated with quite a number of risk factors.
Some of them include :

  • Bleeding
  • Blood clots
  • Valve dysfunction
  • Heart rhythm problems
  • Infections
  • Stroke
  • Death

9) When is the right time to undergo Mitral Valve Replacement ?

Based upon the diagnosis of your condition, your cardiologist will recommend the best treatment procedure to follow with. If the extremity of your condition requires a surgery, then it must be performed as soon as possible before the condition can worsen and lead to any grievous circumstances. Upon the surfacing of symptoms like chest pain, shortness of breath or dizziness, your cardiologist or doctor must be consulted and the required treatment must be followed.

10) What are pre-diagnostic measures in Mitral Valve Replacement ?

A thorough check of the patients’ medical history and family history of heart diseases is done.
Some of the other tests that follow prior to the surgery are :

  • Physical Examination
  • Echocardiogram: to measure the video images of the heart using sound waves.
  • Electrocardiogram: to measure the electrical activity of your heart.
  • Chest X-Ray: to check the presence of enlargement of the heart, which is an indicator of aortic stenosis.
  • Cardiac Computerised Tomography (CT) Scan
  • Cardiac MRI Scan
  • Cardiac Catheterization

11) How is Mitral Valve Replacement performed ?

Mitral Valve Replacement is the medical procedure conducted to replace the affected mitral valve in order to restore normal blood flow. It can be conducted through open heart surgery or through a minimally invasive approach. A local anaesthetic is administered to the patient to minimizse pain. An incision is made in the chest region, followed by the separation of the breast bone and the mitral valve is replaced by a mechanical one or a bio-prosthetic one made up of pig, cow or human heart tissue. Some cardiologists suggest mitral repair as it reduces the risk of bleeding and blood clot formation. In a minimally invasive surgery, three to four incisions are made and a catheter is inserted through one of the incisions and the procedure is conducted externally by a specialist surgeon.

12) How long will Mitral Valve Replacement take ?

A Mitral Valve Replacement Surgery may take around two to four hours to be performed successfully. However, a minimally invasive surgery may take longer.

13) What components are used in Mitral Valve Replacement?

The components used for the surgery are the basic surgical tools required for the procedure. Some additional components that might be required are the mechanical valves or the bio- prosthetic valves that needs to be replaced with.

14) Will I experience pain?

A minimal amount of pain might be experienced due to the surgery in the chest region. There might be a sharp, pain and if the medications are consumed as instructed by your doctor, then it will help in toning down the pain. Any kind of severe or extreme pain must immediately be reported and dealt without any further delay.

15) What is the duration of recovery?

The recovery from a Mitral Valve Replacement may take several weeks for the healing of the rib cage and one or two months for complete recovery.

16) What is the cost of Mitral Valve Replacement in India ?

Cost of Mitral Valve Replacement Surgery in India varies across different cities and hospitals.

Cost of Mitral Valve Replacement Surgery in India
CITY  COST
Cost of Mitral Valve Replacement Surgery in Mumbai      INR 325000- INR 525000    
Cost of Mitral Valve Replacement Surgery in Bangalore INR 320000- INR 520000
Cost of Mitral Valve Replacement Surgery in Delhi INR 320000- INR 520000
Cost of Mitral Valve Replacement Surgery in Chennai      INR 315000- INR 515000