Minimally Invasive Mitral Valve Surgery
Our leading mitral valve surgeon has performed nearly 400 minimally invasive mitral valve repairs or replacements, including complex mitral valve surgeries. This level of experience is found in only a handful of surgeons nationally and makes it possible to repair rather than replace the valve in almost all cases of degenerative mitral valve disease. Valve replacement may be needed if the valve is scarred from illnesses like rheumatic fever or heart attack.
During valve surgery, the physician makes a one to one-and-a-half-inch incision (figure 1) in the right chest between the ribs. The surgeon uses long, thin instruments to work inside the heart and repair the valve. The patient is connected to a heart-lung machine to redirect blood flow and stop the workload of the heart during the procedure.
The mitral valve is like the canopy of a parachute (figure 2) with chords that anchor to muscles and hold the valve in place. If one of the chords becomes stretched or damaged, it can cause imbalance and leakage back into the upper heart chamber.
Repairing the mitral valve involves fixing the two leaflets (flaps) by replacing damaged chords with Gore-Tex® sutures and placing a ring of metal or plastic around the top of the valve (called an annuloplasty) to reinforce the repair and prevent future leaks. In some repairs, a small, damaged portion of the valve may be removed.
Our surgeons prefer to repair rather than replace a valve for degenerative disease, since your own valve will last much longer than an artificial valve. There are cases, however, where your own valve is damaged beyond repair. In these situations, using a mechanical valve or one made from cow, pig or human heart tissue is the best option.
A minimally invasive valve repair or replacement typically allows a shorter hospital stay, quicker recovery, fewer blood transfusions and less pain than conventional open heart surgery. On average, patients remain in the hospital for three to five days. The recovery period is about three weeks. Some people resume office work two weeks after going home.
In addition, studies now show this minimally invasive approach offers better outcomes in mitral valve repair than the robotic approach¹, with shorter recovery than conventional open heart surgery. For that reason, the procedure is quickly becoming the new gold standard in centers of excellence.
For those who are not a candidate for valve surgery due to health risks, a MitraClip device, about the size of a small paper clip, is used to clamp together the two leaflets of the mitral valve. This closes the valve more completely to reduce leakage.
Our interventional cardiologists insert a narrow tube called a catheter in a vein at the top of the leg and advance the MitraClip to the mitral valve in the heart. It is precisely positioned above the leak in the valve, and the arms of the clip hold the valve leaflets together to reduce blood seeping back into the atrium.
Patients generally go home from the hospital the next day, and recovery time at home is minimal. Most patients see significant improvement in their symptoms and their quality of life soon after the procedure.
Conventional Open Heart Surgery
During conventional open heart surgery to repair your own valve or replace it with a biological or mechanical valve, your surgeon will make an incision down the middle of your chest and cut open your breastbone to access your heart. This opening of the breastbone is called a sternotomy.
You will be put on a heart-lung bypass machine during the procedure, which will do the work of your heart. This allows your heart to be still during the procedure.
In the past, conventional open heart surgery was the only way to perform mitral valve surgery. Today, it is still an important option for certain complex or emergency cases.
After conventional open heart surgery, you will typically recover in the hospital for five to seven days. You can resume most activity in about four to six weeks. For the first six weeks, however, you will not be able to lift heavy objects or perform activities that strain your upper arm muscles or chest muscles.