Mitral Valve Replacement: Open

What is an open mitral valve replacement?

An open mitral valve replacement is a surgery to replace a poorly working mitral valve with an artificial valve. Your heart has 4 valves. These valves help blood flow through the heart and out to the body by promoting forward flow and preventing backflow. The mitral valve is 1 of the heart’s 4 valves. The mitral valve lies between the 2 chambers on the left side of the heart. It allows blood to flow from the left atrium (top chamber) to the left ventricle (bottom chamber) in the heart. When the mitral valve is open, it enables blood to flow from your lungs and left atrium to your left ventricle, the heart's main pumping chamber. When the left ventricle contracts to pump blood into your body, the mitral valve closes. This prevents blood from leaking backwards into your lungs.

Your healthcare provider will replace your poorly working mitral valve with an artificial valve. This will ensure that blood can flow into the left ventricle and then flow out to the body normally, without putting extra stress on the heart. The surgery is called open because it uses a traditional larger cut (incision) to expose the heart. This cut is larger than the one used in minimally invasive mitral valve replacement surgery.

Why might I need an open mitral valve replacement?

The procedure may be needed if the mitral valve is working poorly. Surgery to fix the mitral valve is often possible. But sometimes the valve needs to be replaced.

Mitral valve stenosis and mitral valve regurgitation (also called mitral insufficiency) are 2 different types of problems that might need valve replacement:

• Mitral valve stenosis. The valve can't open fully. Less blood is able to move from the left atrium into the left ventricle.

• Mitral valve regurgitation. The valve leaks. Some blood flows back into the left atrium instead of moving forward into the left ventricle.

These valve problems can lead to such symptoms as severe tiredness (fatigue), shortness of breath, fluid buildup in the lungs (pulmonary edema) or legs (edema), and heart palpitations. If these symptoms become severe or the valve is severely damaged, you may need surgery.

Both mitral stenosis and mitral regurgitation can result from general aging of the valve. Other causes of mitral valve disease include:

• Coronary artery disease (ischemic heart disease)

• Infection of the heart valves

• Heart failure

• Rheumatic fever

• A heart problem you're born with (congenital heart defect)

What are the risks of an open mitral valve replacement?

Most people who have an open mitral valve replacement have a successful outcome. But there are certain risks. Your particular risks will vary based on your overall health, your age, and other factors. Talk with your healthcare provider about any concerns that you have. Possible risks include:

• Infection

• Bleeding

• Irregular heart rhythms (arrhythmias), possibly needing a permanent pacemaker

• Blood clots leading to stroke or heart attack

• Complications from anesthesia

• The valve keeps leaking 

• Damage to nearby organs

• Memory loss or problems focusing

Certain things increase the risk of complications, such as:

• Long-term (chronic) illness, including diabetes and kidney problems

• Other heart conditions

• Lung problems

• Being older

• Being a person of size

• Smoking

• Infections

• Vascular disease

How do I get ready for an open mitral valve replacement?

As you plan for the surgery, you and your healthcare provider will talk about the kind of valve that will work best for you. A biological valve or a mechanical valve may be used.

• Biological valves. These are made mainly from pig, cow, or human heart tissue. Biological valves don’t last as long as mechanical valves

• Mechanical valves. These are artificial. If you receive a mechanical valve, you 'll need to take blood-thinning medicine for the rest of your life. This is to help prevent clots that can form on the valve. These clots may cause stroke. Or they may cause the working part of the valve to become frozen and not work anymore.

Talk with your healthcare provider about how to get ready for your upcoming surgery. Remember the following:

• Follow any directions you're given for not eating or drinking before surgery.

• Try to stop smoking before your surgery. Ask your provider about ways to stop.

• Tell your provider about all medicines (prescription and over-the-counter), vitamins, herbs, supplements, and illegal drugs that you're taking.

• Follow your provider's instructions about taking medicines. You may need to stop taking certain ones before your surgery. These may include blood-thinning medicines like warfarin or aspirin. Be clear on which medicines to stop and when, as well as which medicines you can continue to take.

• Tell your provider if you're sensitive to or are allergic to any medicines, iodine, latex, tape, or anesthetic agents (local and general).

• Let your provider know if you have a pacemaker or any other implanted device.

• Tell your provider if you're pregnant or think you could be pregnant.

You may need to arrive at the hospital the day before or the morning of your surgery. This is a good time to ask any questions you have about the procedure. You may also need some routine tests before the surgery to check your health. These may include:

• Chest X-ray

• Electrocardiogram (ECG)

• Blood tests

• Echocardiogram

• Coronary angiogram (to assess blood flow in your heart arteries)

About 1 hour before the surgery, someone will give you medicines to help you relax. In most cases your surgery will proceed as planned. But sometimes another emergency might delay your surgery for a short time.

What happens during an open mitral valve replacement?

Check with your healthcare provider about the details of your procedure. In general, during your open mitral valve replacement:

• You'll be given anesthesia before the surgery starts. This will cause you to sleep deeply. You won't feel pain during the procedure. Afterwards, you won’t remember the surgery.

• The surgery will take a few hours. Family and friends should stay in the waiting room, so the surgeon can update them.

• Your surgeon will make a cut (incision) down the middle of your chest. To access your heart, your surgeon will separate your breastbone.

• The surgery team will attach you to a heart-lung machine. This machine will act as your heart and lungs during the procedure.

• Your surgeon will remove your current mitral heart valve and replace it with a new valve.

• The surgery team will remove the heart-lung machine.

• The team will connect your breastbone back together.

• The team will then stitch (suture) or staple the cut in your skin back together.

What happens after an open mitral valve replacement?

In the hospital

• You'll begin your recovery in the intensive care unit or a recovery room.

• When you wake up, you might feel confused at first. You might wake up a couple of hours after the surgery, or a little later.

• Most people who have mitral valve replacement notice immediate symptom relief after their surgery.

• The team will carefully watch your vital signs. This includes your heart rate, blood pressure, and breathing. You may be hooked up to several machines so the nurses can check these more easily.

• You may have a tube in your throat to help you breathe. This may be uncomfortable, and you won’t be able to talk. The tube will be removed when you're strong enough to breathe on your own. This is often within 24 hours.

• You may have a chest tube to drain excess fluid from your chest.

• Bandages will cover your incision. These can often come off in a few days.

• You'll feel some soreness, but you shouldn’t feel severe pain. If you have pain, you can ask for pain medicine.

• Soon after surgery, you'll likely be encouraged to get up and sit in a chair. In 1 or 2 days, you should be able to walk with help.

• You may do breathing therapy to help remove fluids that collect in your lungs during surgery.

• You'll likely be able to drink liquids once the breathing tube is removed. This is often the day after surgery. You can have regular foods as soon as you can handle them.

• You may need to wear elastic stockings or compression devices on your legs. This is to help blood circulate through your leg veins.

• You 'll likely need to stay in the hospital for several days.

At home

• Make sure you have someone to drive you home from the hospital. You'll also need some help at home for a while.

• Be aware that you may tire easily after the surgery. But you'll slowly start to regain your strength. It may take a few weeks to fully recover from your surgery.

• After you go home, take your temperature and weigh yourself every day. Call your healthcare provider if your temperature is over 100.4°F (38˚C), or as advised by your provider, or if your weight changes.

• Ask your provider about when it's safe for you to drive.

• Don't lift anything heavy for a few weeks. Ask your provider about what is safe for you to lift.

• Follow all the instructions your provider gives you for medicines, exercise, diet, and wound care.

• Know what type of valve you have. If you have a mechanical valve, you'll likely need to take blood-thinning medicine. This is medicine that helps prevent clots. With some blood-thinning medicines, you may need to have frequent blood tests to check the how the medicine is working.

• Make sure all your dentists and other healthcare providers know about your health history. You may need to take antibiotics before certain medical and dental procedures. This is to prevent getting an infection on your replacement valve.

• Keep all follow-up appointments. You'll likely have your stitches or staples removed in a follow-up appointment in 7 to 10 days.

• Follow your healthcare provider's suggestions about starting a cardiac rehab (rehabilitation) program. This slowly reintroduces you to a normal lifestyle. Cardiac rehab starts in the hospital with simple walking. It progresses to a regular exercise routine. It also includes teaching about eating a nutritious diet. Committing to healthier habits can prevent future heart problems.

Next steps

Before you agree to the test or the procedure make sure you know:

• The name of the test or procedure

• The reason you are having the test or procedure

• What results to expect and what they mean

• The risks and benefits of the test or procedure

• What the possible side effects or complications are

• When and where you are to have the test or procedure

• Who will do the test or procedure and what that person’s qualifications are

• What would  happen if you did not have the test or procedure

• Any alternative tests or procedures to think about

• When and how you will get the results

• Who to call after the test or procedure if you have questions or problems

• How much you will have to pay for the test or procedure