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Blood that flows between different chambers of your heart must flow through a valve. This valve is called the mitral valve. It opens up enough so blood can flow from one chamber of your heart (left atria) to the next chamber (left ventricle). It then closes, keeping blood from flowing backwards.

Mitral valve surgery is surgery to either repair or replace the mitral valve in your heart.

In open surgery, the surgeon makes a large incision (cut) in your breastbone to reach the heart.

See also: Mitral valve surgery - minimally invasive

Alternative Names

Mitral valve replacement - open; Mitral valve repair - open; Mitral valvuloplasty

Description

Before your surgery, you will receive general anesthesia. This will make you unconscious and unable to feel pain during the entire procedure.

  • Your surgeon will make a 10-inch-long cut in the middle of your chest.
  • Next, your surgeon will separate your breastbone to be able to see your heart.
  • Most people are connected to a heart-lung bypass machine or bypass pump. Your heart is stopped while you are connected to this machine. This machine does the work of your heart while your heart is stopped.
  • A small cut is made in the left side of your heart so your surgeon can repair or replace the mitral valve.

If your surgeon can repair your aortic valve, you may have:

  • Ring annuloplasty -- The surgeon repairs the ring-like part around the valve by sewing a ring of metal, cloth, or tissue around the valve.
  • Valve repair -- The surgeon trims, shapes, or rebuilds 1 or more of the 3 leaflets of the valve. The leaflets are flaps that open and close the valve.

If your mitral valve is too damaged, you will need a new valve. This is called replacement surgery. Your surgeon will remove your mitral valve and sew a new one into place. There are two main types of new valves:

  • Mechanical -- made of man-made materials, such as cloth, metal, or ceramic. These valves last the longest, but you will need to take blood-thinning medicine, such as warfarin (Coumadin) or aspirin, for the rest of your life.
  • Biological -- made of human or animal tissue. These valves last 12 to 15 years, but you may not need to take blood thinners for life.

Once the new or repaired valve is working, your surgeon will

  • Close your heart and take you off the heart-lung machine.
  • Place catheters (tubes) around your heart to drain fluids that build up.
  • Close your breastbone with stainless steel wires. It will take about 6 weeks for the bone to heal. The wires will stay inside your body.

You may have a temporary pacemaker connected to your heart until your natural heart rhythm returns.

This surgery may take 3 to 6 hours.

Why the Procedure Is Performed

You may need surgery if your mitral valve does not work properly.

  • A mitral valve that does not close all the way will allow blood to leak back into the left atria. This is called mitral regurgitation.
  • A mitral valve that does not open fully will restrict blood flow. This is called mitral stenosis.

You may need open-heart valve surgery for these reasons:

  • Changes in your mitral valve are causing major heart symptoms, such as angina (chest pain), shortness of breath, syncope (fainting spells), or heart failure.
  • Tests show that the changes in your mitral valve are beginning to seriously affect your heart function.
  • Your doctor may want to replace or repair your mitral valve at the same time you are having open-heart surgery for another reason.
  • Your heart valve has been damaged by endocarditis (infection of the heart valve).
  • You have received a new heart valve in the past, and it is not working well, or you have other problems such as blood clots, infection, or bleeding.
Risks

Risks for any surgery are:

Possible risks from having open-heart surgery are:

  • Heart attack or stroke
  • Incision infection, which is more likely to happen in people who are obese, have diabetes, or have already had this surgery
  • Post-pericardiotomy syndrome, which is a low-grade fever and chest pain. This could last up to 6 months.
  • Memory loss and loss of mental clarity, or "fuzzy thinking."
  • Heart rhythm problems
Before the Procedure

Always tell your doctor or nurse:

  • If you are or could be pregnant
  • What drugs you are taking, even drugs, supplements, or herbs you bought without a prescription

You may be able to store blood in the blood bank for transfusions during and after your surgery. Ask your surgeon about how you and your family members can donate blood.

For the 2-week period before surgery, you may be asked to stop taking drugs that make it harder for your blood to clot. These might cause increased bleeding during the surgery.

  • Some of them are aspirin, ibuprofen (Advil, Motrin), and naproxen (Aleve, Naprosyn).
  • If you are taking warfarin (Coumadin) or clopidogrel (Plavix), talk with your surgeon before stopping or changing how you take these drugs.

Prepare your house for when you get home from the hospital.

The day before your surgery. Shower and shampoo well. You may be asked to wash your whole body below your neck with a special soap. Scrub your chest 2 or 3 times with this soap. You also may be asked to take an antibiotic, to guard against infection.

During the days before your surgery:

  • Ask your doctor which drugs you should still take on the day of your surgery.
  • If you smoke, you must stop. Ask your doctor for help.
  • Always let your doctor know if you have a cold, flu, fever, herpes breakout, or any other illness in the time leading up to your surgery.

On the day of the surgery:

  • You will usually be asked not to drink or eat anything after midnight the night before your surgery. This includes Chewing Gum and using breath mints. Rinse your mouth with water if it feels dry, but be careful not to swallow.
  • Take the drugs your doctor told you to take with a small sip of water.
  • Your doctor or nurse will tell you when to arrive at the hospital.
After the Procedure

Expect to spend 4 to 7 days in the hospital after surgery. You will wake up in the intensive care unit (ICU) and recover there for 1 or 2 days. Two to 3 tubes will be in your chest to drain fluid from around your heart. They are usually removed 1 to 3 days after surgery.

You may have a catheter (flexible tube) in your bladder to drain urine. You may also have intravenous (IV, in the vein) lines to get fluids. Nurses will closely watch monitors that show information about your vital signs (pulse, temperature, and breathing).

You will be moved to a regular hospital room from the ICU. Your nurses and doctors will continue to monitor your heart and vital signs until you are stable enough to go home. You will receive pain medicine to control pain around your incision.

Your nurse will help you slowly resume some activity. You may begin a program to make your heart and body stronger.

Outlook (Prognosis)

Mechanical heart valves do not fail often. However, blood clots develop on them. If a blood clot forms, you may have a stroke. Bleeding can occur, but this is rare.

Biological valves tend to fail over time. But they have a lower risk of blood clots.

References

Fullerton DA, Harken AH. Acquired Heart disease: valvular. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2008:chap 62.

Otto CM, Bonow RO. Valvular heart disease. In: Libby P, Bonow RO, Mann DL, Zipes DP, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 8th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 62.

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Definition

Mitral valve surgery is surgery that can either repair or replace the mitral valve in your heart.

Blood that flows between different chambers of your heart must flow through a valve. One such valve is called the mitral valve. It opens up enough so blood can flow from one chamber of your heart (left atria) to the next chamber (left ventricle). It then closes, keeping blood from flowing backwards.

In open surgery, the surgeon makes a large cut in your breastbone to reach the heart.

See also: Mitral valve surgery - minimally invasive

Alternative Names

Mitral valve replacement - open; Mitral valve repair - open; Mitral valvuloplasty

Description

Before your surgery, you will receive general anesthesia. This will make you asleep and pain-free during the entire procedure.

  • Your surgeon will make a 10-inch-long cut in the middle of your chest.
  • Next, your surgeon will separate your breastbone to be able to see your heart.
  • Most people are connected to a heart-lung bypass machine or bypass pump. Your heart is stopped while you are connected to this machine. This machine does the work of your heart while your heart is stopped.
  • A small cut is made in the left side of your heart so your surgeon can repair or replace the mitral valve.

If your surgeon can repair your mitral valve, you may have:

  • Ring annuloplasty -- The surgeon repairs the ring-like part around the valve by sewing a ring of metal, cloth, or tissue around the valve.
  • Valve repair -- The surgeon trims, shapes, or rebuilds one or more of the three leaflets of the valve. The leaflets are flaps that open and close the valve.

If your mitral valve is too damaged, you will need a new valve. This is called replacement surgery. Your surgeon will remove your mitral valve and sew a new one into place. There are two types of mitral valves:

  • Mechanical -- made of man-made (synthetic) materials, such as a metal like titanium. These valves last the longest, but you will need to take blood-thinning medicine, such as warfarin (Coumadin) or aspirin, for the rest of your life.
  • Biological -- made of human or animal tissue. These valves last 10 to 12 years, but you may not need to take blood thinners for life.

Once the new or repaired valve is working, your surgeon will:

  • Close your heart and take you off the heart-lung machine.
  • Place catheters (tubes) around your heart to drain fluids that build up.
  • Close your breastbone with stainless steel wires. It will take about 6 weeks for the bone to heal. The wires will stay inside your body.

You may have a temporary pacemaker connected to your heart until your natural heart rhythm returns.

Your surgeon may also perform coronary artery bypasssurgery at the same time, if needed.

This surgery may take 3 - 6 hours.

Why the Procedure Is Performed

You may need surgery if your mitral valve does not work properly.

  • A mitral valve that does not close all the way will allow blood to leak back into the left atria. This is called mitral regurgitation.
  • A mitral valve that does not open fully will restrict blood flow. This is called mitral stenosis.
  • A valve defect that you have had since birth is called mitral valve prolapse.

You may need open-heart valve surgery for these reasons:

  • Changes in your mitral valve are causing major heart symptoms, such as angina(chest pain), shortness of breath, fainting spells (syncope), or heart failure.
  • Tests show that the changes in your mitral valve are beginning to seriously affect your heart function.
  • Your doctor may want to replace or repair your mitral valve at the same time as you are having open-heart surgery for another reason.
  • Your heart valve has been damaged by endocarditis (infection of the heart valve).
  • You have received a new heart valve in the past, and it is not working well, or you have other problems such as blood clots, infection, or bleeding.
Risks

Risks for any surgery are:

Possible risks from having open-heart surgery are:

  • Heart attack or stroke
  • Heart rhythm problems
  • Infection in the cut, which is more likely to happen in people who are obese, have diabetes, or have already had this surgery
  • Memory loss and loss of mental clarity, or "fuzzy thinking."
  • Post-pericardiotomy syndrome, which is a low-grade fever and chest pain. This could last for up to 6 months.
Before the Procedure

Always tell your doctor or nurse:

  • If you are or could be pregnant
  • What drugs you are taking, even drugs, supplements, or herbs you bought without a prescription

You may be able to store blood in the blood bank for transfusions during and after your surgery. Ask your surgeon how you and your family members can donate blood (autologous donation).

For the 2-week period before surgery, you may be asked to stop taking drugs that make it harder for your blood to clot. These might cause increased bleeding during the surgery.

  • Some of these drugs are aspirin, ibuprofen (Advil, Motrin), and naproxen (Aleve, Naprosyn).
  • If you are taking warfarin (Coumadin) or clopidogrel (Plavix), talk with your surgeon before stopping or changing how you take these drugs.

Prepare your house for when you get home from the hospital.

The day before your surgery, shower and shampoo well. You may be asked to wash your whole body below your neck with a special soap. Scrub your chest two or three times with this soap. You also may be asked to take an antibiotic to guard against infection.

During the days before your surgery:

  • Ask your doctor which drugs you should still take on the day of your surgery.
  • If you smoke, you must stop. Ask your doctor for help.
  • Always let your doctor know if you have a cold, flu, fever, herpes breakout, or any other illness in the time leading up to your surgery.

On the day of the surgery:

  • You will usually be asked not to drink or eat anything after midnight the night before your surgery. This includes chewing gum and using breath mints. Rinse your mouth with water if it feels dry, but be careful not to swallow.
  • Take the drugs your doctor told you to take with a small sip of water.
  • Your doctor or nurse will tell you when to arrive at the hospital.
After the Procedure

Expect to spend 4 to 7 days in the hospital after surgery. You will wake up in the intensive care unit (ICU) and recover there for 1 or 2 days. Two to three tubes will be in your chest to drain fluid from around your heart. They are usually removed 1 to 3 days after surgery.

You may have a flexible tube (catheter) in your bladder to drain urine. You may also have intravenous (IV, in the vein) lines to get fluids. Nurses will closely watch monitors that show information about your vital signs (pulse, temperature, and breathing).

You will be moved to a regular hospital room from the ICU. Your nurses and doctors will continue to monitor your heart and vital signs until you are stable enough to go home. You will receive pain medicine to control pain around your surgical cut.

Your nurse will help you slowly resume some activity. You will be asked to begin a physical therapy program to make your heart and body stronger.

Outlook (Prognosis)

Mechanical heart valves do not fail often. They last from 12 to 20 years. However, blood clots develop on them. If a blood clot forms, you may have a stroke. Bleeding can occur, but this is rare.

Biological valves tend to fail over time. But they have a lower risk of blood clots.

References

Fullerton DA, Harken AH. Acquired heart disease: valvular. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2008:chap 62.

Otto CM, Bonow RO. Valvular heart disease. In: Libby P, Bonow RO, Mann DL, Zipes DP, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 8th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 62.

Reviewed By

Review Date: 01/26/2011

Shabir Bhimji, MD, PhD, Specializing in General Surgery, Cardiothoracic and Vascular Surgery, Midland, TX. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

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Related questions

What is the reason why one could need a mitral valve surgery?

A mitral valve surgery is done to repair or replace a mitral valve which connects the two sides of the heart. If the valve is loose, blood is capable of flowing in the wrong direction. The surgery will fix this problem.


What is mitral valve replacement?

Cardiothoracic and cardiovascular surgeons perform mitral valve repair. Surgeons are trained during their residency to perform these procedures, although a certain level of skill is required for perfection of the technique.


Is there a Cure for mitral valve prolapse?

Most people do not require treatment for mitral valve prolapse and remain asymptomatic. There is no cure for mitral valve prolapse but if a person develops symptoms medications are the common treatment and on rare occasions, surgery may be recommended.


For what reasons may an aortic valve replacement surgery be needed?

Aortic valve replacement surgery will be required if the valve in the heart is either too narrow for all of the blood to pass through or if the valve is leaking. This valve is very important as it prevents blood from rushing back into the heart after it has been pumped out.


What hospital in the US performs the largest number of mitral valve repairs?

The Cleveland Clinic in Ohio is known for performing the largest number of mitral valve repairs in the United States. Mitral valve repair is a specialized surgical procedure to treat mitral valve regurgitation, a condition where the valve doesn't close properly, causing blood to flow backward in the heart. The Cleveland Clinic's Heart, Vascular & Thoracic Institute is renowned for its expertise in cardiac surgery, including mitral valve repair procedures.


What is the medical term meaning backflow of blood through the mitral valve?

The medical term for backflow of blood through the mitral valve is mitral regurgitation.


How do heart attacks affect the mitral valve?

Heart attacks that damage the structures that support the mitral valve are a common cause of mitral valve insufficiency. Myxomatous degeneration can cause a "floppy" mitral valve that leaks.


Once you undergo open heart surgery for asd closureIs it possible that the problem may reccur afterwards due to some reasons?

is it normal to be tired months after mitral valve repair sugery?


The mitral valve is closed when?

The mitral valve is closed when the left ventricle is contracting.


2 other names for the bicuspid valve?

The bicuspid valve is also known as the mitral valve or the left atrioventricular valve.


What is the medical term meaning narrowing of the mitral valve?

Mitral stenosis is the medical term meaning narrowing of the mitral valve.


Another name for the left AV valve?

The left atrioventricular valve is also known as the mitral valve.