Mitral Valve Surgery – The Nebraska Medical Center

The mitral valve is the valve that’s between
the collecting chamber on the left side of the heart where the blood comes from the lungs
and goes into the left ventricle. The left ventricle is the main pumping chamber
of the heart. So if you have a problem with your mitral
valve, you have either leaking that goes back into the atrium and thus into the lungs when
the heart contracts. Or mitral stenosis, a narrowing of the mitral valve. Which is less
common in the US. It would impede blood flow from the collecting
chamber into the ventricle. The most common symptom of a patient with
mitral valve disease is shortness of breath. It would typically start when they exert themselves.
But fatigue, tiredess is something that people would describe over a period of time.
There’s a small percentage of patients that have mitral valve problems that happen suddenly
or acutely due to a heart attack or something else.
They would have very sudden shortness of breath. But the average person who has a leaking mitral
valve would have no symptoms for a prolonged period of time, and then over a slow period
of time would develop shortness of breath with exertion. The most common cause we see is from a flopply
valve or a prolapsing mitral valve. Most of those can be repaired.
So most floppy mitral valves, in an experienced mitral valve center, can be repaired.
That having been said, there are some patients who have severe disease in the valve, if they’ve
had infection of the valve or rheumatic fever, who need a valve replacement.
The good news there is a very good second choice is a valve replacement. We have a couple
options in the United States. One would be a mechanical heart valve. Which
is typically a tilting disc mechanical valve. That would require blood thinners.
The other would be a tissue heart valve, a pig valve is a typical example of that.
The bottom line is, in the vast majority of patients, we try to repair your own mitral
valve. Which means the patient would not have to be on a blood thinner.
And the valve should have excellent long term freedom from problems. If you have a mechanical valve, we would typically
put a mechanical valve in a younger person. The reason, especially in the mitral position,
as opposed to the aortic valve position, because tissue heart valves like a pig valve in the
mitral position can wear out over time. They become calcified as the years go by.
After 10, 15, certainly by 20 years, there is a reasonable chance that the valve has
degenerated some and would require another operation.
On the other hand, mechanical heart valves do not wear out. So mechanical heart valves,
the ones implanted in the United States have never had a mechanical failure in millions
of implants. The only reason a mechanical heart valve would
ever need to come out is if it got infected, which is rare, but can happen. Or it got clot
on it. That can happen if patients have problems
with their anti-coagulation. Again, those are unusual circumstances.
Mechanical heart valves are a reasonable option for a young person if they do not have a repairable
valve. Most commonly, the mitral valve has two leaflets
to it. And those leaflets are supposed to close when the heart contracts.
One of those leaflets will prolapse and the blood will leak back into the atrium.
So the operation consists of typically going through a sternotomy incision. We usually
make a small sternotomy incision. The patient is on a heart-lung bypass. That
is required to go inside the heart to do the repair.
We approach the mitral valve through the atrium, the collecting chamber of the heart. And we
have an excellent view of the valve through the atrium.
Typically in order to repair a floppy vavle, we do a couple things.
One is, when we have one of those leaflets described as prolapsing, we remove a segment
of that prolapsing leaflet and the attached cordae which are the struts that hold that
valve. We sucher the other parts back together. And
then we typically put a ring around the anulus of that valve because what happens when patients
have mitral regurgitation is that anulus of the valve increases over time.
We need to bring it back down to normal size so those leaflets can close on themselves.
Those are the two most common things we do to repair a floppy valve.
Also there are times when we replace those struts, those cords with artificial cords.
Typically those are gortex type sucher which are like what you’d see in a rain jacket.
Those work very nicely in the long term to support the valve.
With those three techniques, that should allow us to repair about 98% of the type of valve
problems we see in patients with floppy valves. Your average person who has it would require
a stay of 4-5 days in the hospital with one day in intensive care.
There are no doubt some patients ready to leave by 3 days after surgery, others may
need 5-6. But I’d say 4-5 days is a typical stay.
Usually it’ll be 2-3 weeks after surgery they’re starting to get back to their routine activities.
If you take all the people who have mitral repair in my experience, I’d say maybe 20-30%
will say right away, “I’m breathing better.” But there’s a good subset of the other patients
who it really takes them 3-4 months to actually notice a significant difference in their breathing.
And I always mention that to patients. There are some very high quality papers that
suggest a surgeon should do at least 10-15.. and certianly if you do more… mitral valve
repairs per year to have good long term results. That would suggest that the majority of these
repairs should be done in a center that does a fair number of mitral repairs; like our
center. The good news is at a center like this with
a that has experience doing mitral repairs, the success rate is better than 99% of the
patient having an excellent result without significant complication.

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