Mitral valve disease (leak or narrowing) can be treated by an operation in which the valve is replaced. The operation is always performed under a general anaesthetic so you will be asleep. The surgeon makes an opening in the middle of the chest through the breast bone to get to the heart. During the operation, the function of the heart and lungs is taken over by a machine (“heart bypass”). The surgeon can then stop the heart and remove the damaged valve. In some cases the surgeon will attempt to repair the valve instead of replacing it. The risk of death for repairing the valve is 1-2% versus 4-5% for replacement. If repair is not possible, then a new replacement valve will be sewn in place. After the operation the breastbone is closed using stainless steel wires and surgical drains (tubes) are positioned in the chest to allow any excess fluid to drain. These are normally taken out after about 24 hours. As a precaution, pacing wires are placed on the surface of the heart in case of a low heart rate (bradycardia) in the early post-operative stage, these are removed 4-5 days after the operation.
There are 2 types of valve which are commonly used:
Tissue Mitral Valves — engineered from a pig or cow heart valve. The main advantage to tissue valves is you don’t have to take Warfarin (blood thinners) but the disadvantage is that it only lasts 10-15 years.
Mechanical Mitral Valves — made from metal. You would need to take Warfarin tablets for life afterwards. This can be very important if you are a woman and thinking about having a family in the future due to the side-effects of the medication and effects on an unborn child. The main advantage of having a metal valve replacement is that it should last for many years and possibly forever.
There is a small risk of death and a very small risk of major complications such as brain damage (1 in 100). Other complications such as bleeding, infection, fluid collecting around the heart or lungs can occur after the operation but these are rarely serious, although they may need treatment. After surgery a short stay on the intensive care unit (usually overnight) is required. You will then remain in hospital for further monitoring of your recovery. This is usually for about 7 days but can be longer. Opening the front of the chest leads to a scar and the chest wall will be sore whilst it heals. The time taken to get fully back to normal varies from person to person but can be up to 3 months.