Your mitral valve is one of the four major valves in your heart. It helps blood flow through your heart and out to the rest of your body.
When this valve isn’t working correctly, it puts stress on your heart. It also makes it difficult for your blood to circulate in a healthy way.
Sometimes, problems with your mitral valve can be managed with medicine or corrected with surgical repairs. These options are less invasive.
However, in severe cases, the valve will need to be replaced entirely. This is called mitral valve replacement surgery.
Problems with your mitral valve are called mitral valve disease. For some people, mitral valve disease is silent and there are no symptoms until the damage is severe. When symptoms occur, they include shortness of breath, lightheadedness, and a rapid heartbeat.
There are two types of mitral valve disease:
- Mitral valve stenosis. In this condition, your mitral valve can’t open all the way. This results in less blood flowing through the chambers of your heart.
- Mitral valve regurgitation. This means that your mitral valve is leaking blood. In this condition, some of the blood that should be traveling through your heart leaks backward instead of forward.
Several factors can lead to mitral valve disease. In some cases, the condition is simply a result of normal aging and the mitral valve wearing out. Certain health conditions can also cause mitral valve disease, including:
Your medical team will help you prepare for your mitral valve replacement surgery. One of the first steps is to discuss with your doctor the type of valve you’ll be receiving. You and your doctor can decide together which type of valve is best for you. There are two options for a replacement mitral valve:
- Biological valves are made from human, cow, or pig heart tissue. They don’t last as long as mechanical valves.
- Mechanical valves are human-made. They are long lasting but have a higher risk of infection. You’ll need to take blood thinners for the rest of your life if you receive a mechanical valve.
You might also need to take some tests a week or two before your surgery. These tests will help your medical team assess your health. Tests might include:
- lab tests
- echocardiogram (transthoracic or transesophageal)
- electrocardiogram (ECG)
- coronary angiogram
In the days right before your surgery, you’ll have specific instructions to follow. Your doctor will give these instructions before your procedure, but general pre-surgery instructions include:
- Pack a bag of essential items.
- Stop taking blood-thinning medications before surgery (talk to your doctor about when to stop and if you should take an injection instead while off oral medications).
- Don’t eat or drink anything after midnight the night before your surgery.
- Remove nail polish, jewelry, contact lenses, and dentures before going into surgery.
Mitral valve replacement is sometimes done as open heart surgery, which involves making a large cut through your breastbone. But there are also minimally invasive options available.
Open heart surgery
There are several steps to a mitral valve replacement procedure. You’ll first be given anesthesia which will put you to sleep and ensure you don’t feel any pain during the procedure. Once you’re under anesthesia, your surgical team will:
- make an incision down the middle of your chest
- separate your breastbone to access your heart
- attach you to a heart-lung machine that will act as a mechanical heart and lungs during the operation
- remove your current mitral valve
- carefully place your new mitral valve
- remove the heart-lung machine
- rewire your breastbone
- stitch or staple your skin back together
Mitral valve replacement surgery takes several hours. You’ll be moved to a recovery room once your surgery is complete. Nurses and other medical staff in the recovery room will monitor you as you wake up from the anesthesia before moving you to a general hospital floor.
Minimally invasive options
Transcatheter mitral valve replacement (TMVR) is a way to replace your valve without open heart surgery. Instead of making a large incision, your surgeon will insert a thin tube into a vein in your groin. The new valve is then guided through the tube to replace the old valve.
As of 2021, there were nine different TMVR devices being studied. None have yet been approved by the FDA.
Robot-assisted mitral valve surgery also eliminates the need for a large incision in your chest. Instead, several small incisions are made. Surgeons control the robotic device as it uses small instruments to perform the surgery.
Robot-assisted surgery typically
All surgery comes with risks, and a major surgery such as mitral valve replacement isn’t right for everyone. Possible risks include:
- blood clots
- infection of incision or heart valve
- malfunction of the replacement valve
- damage to nearby organs
- memory loss
- an irregular heartbeat
Certain people have a higher risk of complications from mitral valve replacement surgery. This includes people who:
- have a weakened immune system or frequently get infections
- have one or more chronic health conditions
- have another heart condition
- have lung health concerns
- have obesity
- have kidney failure
- have congestive heart failure
- have had a stroke
Additionally, people who are older or whose overall health isn’t a good fit for major surgery might benefit more from other treatment options.
You and your doctor can discuss your mitral valve disease, your risk factors, and if replacement is the best choice for you. They can help you weigh your options and make a decision.
Mitral valve repair can help people with mitral valve disease improve their quality of life. It can reduce symptoms and help you feel much better than you did before surgery.
Your surgery might be followed by attending a program called cardiac rehabilitation. Cardiac rehab programs are designed to help you recover from your surgery and will teach you exercises and other tips to make the most of your new mitral valve.
It’s important to adopt a healthy lifestyle when you have a replacement mitral valve. Your doctor can help you develop exactly what that means for you, but common parts of a healthy lifestyle include:
- not smoking
- eating a heart-healthy diet
- limiting the amount of alcohol you drink
- getting regular exercise
- getting enough sleep
- managing your stress levels
Additionally, you might have changes to your medications after a mitral valve replacement. For instance, If you received a mechanical valve replacement, you’ll need to take blood thinners daily.
You’ll have regular checkups to make sure your replacement valve is working. If you received a biological valve, it may eventually need to be replaced again.
A mitral valve replacement isn’t the only option for treating mitral valve disease. In fact, other options are often preferred because they are less invasive and can preserve your original heart valve. Alternatives to mitral valve replacement include:
- Medications such as blood thinners, blood pressure-reducing medications, and diuretics can all be prescribed to help treat mitral valve disease. These medications can’t repair your mitral valve, but they can improve how your heart works and how your blood circulates.
- MitraClip is a minimally invasive procedure that can help you avoid surgery. Doctors can insert a clip through a vein in your leg and then carefully guide it up to your arteries and heart. They can then use the clip to fix leaks in your mitral valve.
- Mitral repair surgery is done when your mitral valve isn’t working correctly but is still healthy enough to be fixed. In repair surgeries, surgeons can fix structural problems so that your valve functions better.
Does Medicare cover mitral valve replacement?
Medicare may cover open heart mitral valve replacement if it is medically necessary. Your doctor will need to send proof of your mitral valve disease and of any previous treatment attempts in order for Medicare to provide coverage.
But the noninvasive TVMR is not approved by the FDA, so it’s not covered by Medicare.
What is the recovery time for a mitral valve replacement?
You’ll likely spend about 5 days in the hospital following mitral valve replacement. Once you return home, it will take several weeks to completely recover from your surgery.
You’ll be tired and sore in the first 2 or 3 weeks after surgery, but you’ll feel better day by day. You’ll have pain medications prescribed to help you manage your recovery, and your doctor will let you know when it’s safe to resume your normal activities.
Will I need a pacemaker after mitral valve replacement?
Some people do receive mitral valve replacement surgery and need a pacemaker at a later time, but this isn’t common. For most people, mitral valve replacement surgery improves their quality of life and eliminates symptoms, such as a racing heart that might be associated with the need for a pacemaker. Talk to your doctor if you are concerned you might need a pacemaker in the future.
Mitral valve replacement surgery is a serious procedure that is done to correct problems with the mitral valve of your heart.
Sometimes, doctors can correct problems with your mitral valve with less invasive procedures like medications or nonsurgical clip insertion. When they can’t, replacement surgery is an option that can improve your quality of life.
Attending a cardiac rehab program after surgery can give you the education and tools you need to make the most of your replacement heart valve.