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Mitral valve replacement surgery may be needed for mitral valve regurgitation or mitral valve stenosis.
Valve replacement is typically done as an open-heart surgery. Minimally invasive types of
surgery may be another option. This document describes open-heart
surgery. For information about minimally invasive surgery, see Heart Valve Replacement Surgery: Minimally Invasive Methods.
During valve surgery, you are given
general anesthesia. Your doctor makes a large incision in your chest. You are placed on a
heart-lung machine during the surgery. Blood is circulated outside of the body
and oxygen is added to it using a heart-lung (cardiopulmonary bypass) machine.
To protect the heart muscle from damage during surgery to replace the heart
valve, the heart may be cooled to slow or stop the heartbeat. The damaged
mitral valve is removed and replaced with an
artificial heart valve. The damaged valve is cut out, and the new valve is sewn
See a picture of an artificial mitral valve after replacement surgery.
Recovery from heart valve surgery
usually involves a few days in an intensive care unit (ICU) of a hospital. Full
recovery from heart valve surgery can take several months. Recovery includes
healing of the surgical incision, gradually building physical endurance, and
You will feel tired and sore for the first few weeks after surgery. You may have some brief, sharp pains on either side of your chest. Your chest, shoulders, and upper back may ache. The incision in your chest may be sore or swollen. These symptoms usually get better after 4 to 6 weeks.
You will probably be able to do many of your usual activities after 4 to 6 weeks. But for at least 6 weeks, you will not be able to lift heavy objects or do activities that strain your chest or upper arm muscles. At first you may notice that you get tired easily and need to rest often. It may take 1 to 2 months to get your energy back.
Even though the surgery repaired your mitral valve, it is still important to eat heart-healthy foods, get regular exercise, not smoke, take your heart medicines, and reduce stress. Your doctor may recommend that you work with a nurse, a dietitian, and a physical therapist to make these changes. This is sometimes called cardiac rehabilitation.
After you have an artificial valve, your heart
function and your life will largely return to normal. If you had symptoms before surgery, you should feel better
than before you had the surgery. For
example, you should no longer have shortness of breath and fatigue. But
if your heart was already severely affected before your surgery, you may
continue to have complications of heart disease.
be able to resume most of your normal activities, although you will have to
continue to monitor your condition. You need to watch out for symptoms of blood
clots and infections.
An artificial valve may need to be replaced
after a period of time. So be sure to see your doctor regularly.
If you have a mechanical heart valve, you are more
likely to develop blood
clots in your heart. So you will take an anticoagulant (blood thinner) for the rest of your
life to help prevent clots.
For both stenosis and regurgitation, valve repair surgery is typically preferred over valve replacement surgery. But if repair surgery is not a good option, replacement surgery might be recommended.
An artificial mitral valve cannot work as well as a
normal mitral valve. So your doctor will likely recommend valve
replacement only if it necessary. It might be necessary if the valve has deteriorated to the point that repair is not an
option or if the anatomy of the valve has been changed by one or more repair
procedures and can no longer be repaired.
You and your doctor will also consider your age and your overall health when you are deciding whether to have surgery.
For acute mitral valve regurgitation, surgery is done immediately to replace or repair the valve.
For chronic regurgitation, surgery might be recommended if:1
Surgery is usually delayed if no
symptoms or signs of heart failure are present. People who have severe mitral valve regurgitation, no
physical symptoms, and whose
left ventricle is functioning normally may be
monitored every 6 to 12 months by their doctor. If follow-up testing shows
enlargement or abnormal function of the left ventricle, surgery is typically recommended.
Surgery for mitral valve stenosis might be recommended if:1
Valve replacement surgery will likely be recommended if you need surgery but cannot have balloon valvotomy or the commissurotomy surgery to repair your mitral valve.
After a diseased mitral valve is replaced, the artificial valve works more like a normal valve and allows blood to flow more normally through the heart. Many people feel better and have a better quality of life after surgery.2
The outcome of mitral valve replacement depends on a person's heart health and overall health, including other health
The exact risks of mitral valve surgery vary
depending on the person's specific condition and general health prior to
surgery. Younger, healthy people have a lower risk of problems while older people with other health problems have a higher risk.
In general, the risks include:
Repair of the heart
valve usually is the preferred surgery for a mitral valve problem. When the mitral valve is seriously damaged, heart valve replacement may
be recommended. The decision whether to repair or replace a
valve is based on many things, including your general health, the
condition of the damaged valve, the presence of other health conditions, and
the expected benefits of surgery.
For more information about the decision to repair or replace a valve, see:
Before you have valve replacement surgery, you and your doctor will decide on which type of valve is right for you. For help with this decision, see:
Complete the surgery information form (PDF)(What is a PDF document?) to help you prepare for this surgery.
Bonow RO, et al. (2008). 2008 Focused update
incorporated into the ACC/AHA 2006 Guidelines for the management of patients
with valvular heart disease: A report of the American College of
Cardiology/American Heart Association Task Force on Practice Guidelines
(Writing committee to revise the 1998 Guidelines for the management of patients
with valvular heart disease). Circulation, 118(15):
Otto CM, Bonow RO (2012). Valvular heart disease. In RO Bonow et al., eds., Braunwald’s Heart Disease: A Textbook of Cardiovascular Medicine, 9th ed., vol. 2, pp. 1468–1539. Philadelphia: Saunders.
November 29, 2011
Rakesh K. Pai, MD, FACC - Cardiology, Electrophysiology & John A. McPherson, MD, FACC, FSCAI - Cardiology
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