What you can expect

Mitral valve repair and mitral valve replacement are done by a heart (cardiac) surgeon. Some people with mitral valve problems may be treated with catheter-based procedures performed by an interventional cardiologist.

If you need heart surgery for another condition in addition to mitral valve disease, your doctor may perform both surgeries at the same time.

Before

You'll receive medication to put you into a deep sleep during the procedure (general anesthesia). You'll be connected to a heart-lung bypass machine, which keeps blood moving through your body during the procedure.

During

Minimally invasive heart surgery generally should be done at medical centers with medical teams experienced in performing these types of procedures.

Mitral valve procedures may be done in the following ways:

• Open-heart surgery, which involves a cut (incision) in the chest.
• Minimally invasive heart surgery, which uses smaller incisions in your chest. Minimally invasive heart surgery may involve a shorter hospital stay, quicker recovery and less pain than open-heart surgery.
• Robot-assisted heart surgery, a type of minimally invasive surgery in which the surgeon sits at a remote area and views the heart on a video monitor. The surgeon uses robotic arms to perform the same movements used in open-heart surgeries. Robotic mitral valve replacement is becoming more common as a surgery option. Together, you and your surgeons will discuss the best surgery option for you.
• Transcatheter procedure, which is done by a cardiologist in the catheterization lab. This type of treatment involves inserting a catheter in a vein and guiding it to the heart. The catheter may be used to deliver tools to repair or replace the valve.

Mitral valve repair

During mitral valve repair surgery, your doctor may:

• Patch holes in a heart valve
• Reconnect the valve leaflets
• Remove excess tissue from the valve so that the flaps can close tightly
• Repair the structure of the mitral valve by replacing cords that support it
• Separate valve leaflets that have fused

Other mitral valve repair procedures include:

• Annuloplasty. Surgeons tighten or reinforce the ring around the valve (annulus). Doctors may perform annuloplasty alone or with other techniques to repair a heart valve.
• Valvuloplasty. This catheter procedure is used to repair a mitral valve with a narrowed opening. It may be done even if you don't have symptoms. The doctor inserts a catheter with a balloon on the tip into an artery in your arm or groin and guides it to the mitral valve. The balloon is inflated, widening the mitral valve opening. The balloon is deflated, and the catheter and balloon are removed.
• Mitral valve clip. In this procedure, the doctor guides a catheter with a clip on its end to the mitral valve through an artery in the groin. The clip is used to fix a torn or leaky mitral valve leaflet. Your doctor may recommend this option if you have severe mitral valve regurgitation and are not a good candidate for mitral valve surgery.

Mitral valve replacement

During mitral valve replacement, your heart surgeon removes the mitral valve and replaces it with a mechanical valve or a valve made from cow, pig or human heart tissue (biological tissue valve).

In some cases, a heart catheter procedure may be done to insert a replacement valve into a biological tissue valve that is no longer working properly. This is called a valve-in-valve procedure.

After

If you've had mitral valve repair or replacement surgery, you'll generally spend a day or more in the intensive care unit (ICU). You'll be given fluids and medications through an IV. Other tubes will drain urine from your bladder and fluid and blood from your chest. You may be given oxygen.

After leaving the ICU, you'll be moved to a regular hospital room for several days. The time you spend in the ICU and hospital can vary depending on your condition and the type of surgery you have.

If you've had a transcatheter procedure, you will stay in the hospital at least overnight but may not need to stay in the ICU. With this approach, there are no tubes needed to drain fluid or blood from your chest.

Your doctors and nurses will monitor your condition and watch for signs of infection at your incision sites. You'll have your blood pressure, breathing and heart rate checked often. Your doctor will also work with you to manage pain you may have after surgery.

You'll be told to gradually increase your activity and to do breathing exercises as you recover. Your nurses will help you take longer and longer walks during your time in the hospital.

You'll be given instructions to follow during your recovery, which will include details about the following:

• How to care for your incisions
• What medications you should take and when
• How to manage pain and other side effects
• The signs and symptoms of infection and when to call your doctor

After mitral valve repair or mitral valve replacement, your doctor will tell you when you can safely return to daily activities, such as working, driving and exercise.