Open Mitral Valve Surgery

Written by Robin Madell | Published on June 4, 2012
Medically Reviewed by George Krucik, MD

What Is Mitral Valve Surgery?

Mitral valve surgery is a treatment for mitral valve disease. Your mitral valve connects the two chambers in the left side of your heart. These are called the left atrium and the left ventricle. The mitral valve allows blood to flow properly through the two chambers.

In mitral valve disease, the mitral valve doesn’t work properly. Mitral valve surgery allows a surgeon to repair or replace your mitral valve.

Mitral valve surgery can be performed in two ways:

  • as a “minimally invasive” procedure, where the surgeon makes several smaller incisions in your chest to reach your heart
  • as an “open” procedure, where the surgeon makes one large incision in your breastbone to access your heart

When Do You Need Mitral Valve Surgery?

Your doctor may recommend surgery if you have any of the following problems:

Mitral Valve Prolapse

In this condition, the mitral valve does not close properly. Instead, the valve bulges up into the atrium.

Mitral Regurgitation

This condition is often a result of mitral valve prolapse. Improper mitral valve closure causes blood to leak back into your left atrium.

Mitral Stenosis

This is a narrowing of the opening in the mitral valve. It restricts blood flow through your heart.

Endocarditis

Endocarditis can cause your valve to be damaged by infection.

Progressive Heart Damage

Damage to the mitral valve can cause serious problems with heart function. This may require surgery.

Other Heart-Related Problems

Surgery may also be needed if valve changes cause serious heart problems, such as chest pain, fainting, difficulty breathing, or heart failure.

When Do You Need Open Mitral Valve Surgery?

Your doctor will advise you whether minimally invasive or open surgery is more appropriate for you.

When possible, your doctor will probably recommend minimally invasive surgery. Minimally invasive surgery generally results in less blood loss, lower risk of infection, and faster recovery.

However, minimally invasive surgery isn’t appropriate for everyone. Some people will need open mitral valve surgery.

Some specific reasons why open surgery may be needed include:

  • a diagnosis of heart disease
  • failure of a previous valve replacement
  • previous heart surgery

Valve replacement may also be performed during other open-heart surgery. This can reduce the need for a second surgery.

How Do You Prepare for Open Mitral Valve Surgery?

It’s important to tell your doctor about any medications you are taking before your procedure. Some drugs may make it harder for your blood to clot. This could cause increased bleeding and other problems during your surgery. Make certain to mention nonprescription drugs and supplements.

You should also tell your doctor if you have a cold, flu, or any other illness in the days leading up to your scheduled surgery. Infection of the heart can be very dangerous.

Women should tell their doctor or nurse if they may be pregnant.

Your doctor may ask you not to eat or drink anything—including water—after midnight the night before surgery. If your doctor gives you medicine to take prior to the surgery, be sure to take it using only a small sip of water.

You will need to spend up to a week in the hospital after surgery. Make certain to prepare your work and family for the time you will be away. Talk to your doctor about any physical and emotional concerns you have for your surgery and hospital stay. That will help you to be as ready as possible for your admission.

You may want to bring a friend or relative to your preadmission appointment. They can help you remember any questions and take notes on what your doctor says.

What Is Involved in Open Mitral Valve Surgery?

You can expect to undergo the following steps as part of open mitral valve surgery:

  • You will receive general anesthesia, to allow you to sleep without pain during the surgery.
  • Your surgeon will make a cut that is 10 inches long through your chest.
  • In order to see your heart, your surgeon will separate your breastbone.
  • You may be hooked up to a heart-lung machine, which will circulate your blood while your heart is stopped for surgery
  • Your surgeon will make a small cut in the left side of your heart in order to repair or replace your mitral valve.

The exact surgical procedure that takes place next depends on whether your valve is being repaired, or completely replaced.

If your mitral valve is not too damaged, your surgeon may try to repair it by:

  • sewing a ring made of metal, tissue, or cloth around the valve to reinforce the outside ring
  • trimming, rebuilding, or reshaping one of the three flaps that allow the valve to open and close

If your mitral valve is too damaged to repair, your surgeon may choose to replace it. This means that your surgeon will remove your damaged mitral valve and sew a new one into place.

Both synthetic valves and biological valves are available. The synthetic ones last longer, but they are more likely to cause clots. You will need to be on blood thinners for the rest of your life. Biological valves only last 10 to 12 years, but do not always require blood thinners.

Surgery will last three to six hours.

What Can You Expect After Open Mitral Valve Surgery?

Immediately following open mitral valve surgery, you will need to spend one to two days in the intensive care unit (ICU) of your hospital.

You will then usually be moved to a regular hospital room. Most people need to spend up to a week in the hospital recovering.

While in the ICU, you will have tubes in your chest to help drain fluid. These tubes are usually removed within three days of your surgery.

What Are the Benefits and Risks of Open Mitral Valve Surgery?

Heart valve surgery can produce several benefits. These include:

  • better quality of life
  • prolonged life
  • reduced heart symptoms

While major complications are rare with open-heart surgeries, all open-heart surgeries do involve some risk. Some people may get an infection in the cut. This is more likely to happen if you are obese or diabetic, or if you have had mitral valve surgery before. Other possible complications include:

  • heart rhythm problems
  • loss of mental clarity
  • low-grade fever

These complications are temporary and should resolve as you recover.

Mitral valve surgery does carry a risk of stroke. According to a study published in the journal Innovations: Technologies and Techniques in Cardiothoracic and Vascular Surgery, the risk is lower for open surgery than minimally invasive surgery. The study found stroke risk to be 2.1 percent for minimally invasive surgery and 1.2 percent for open surgery (Falk).

Stroke risk is also higher for artificial valves than biological valves. Synthetic valves are more likely to develop blood clots.

However, synthetic valves have other advantages. They can last for up to 20 years. For younger patients, this may double the time between valve replacements. The longer useful lifespan for mechanical valves may be less of a concern for elderly recipients.

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