What is a minimally invasive mitral valve repair?

A mitral valve repair is a surgery to fix issues of the mitral valve. This surgery can be done with minimally invasive techniques, which is preferable for many patients over open-heart surgery. In this article, Mr Alberto Albanese, a consultant cardiothoracic surgeon, explains the surgery and in which cases it is conducted.

The mitral valve is a part of the heart that keeps the blood flow in the correct direction – from the upper left heart chamber (called the left atrium) to the lower left heart chamber (called the left ventricle).

Issues in the mitral valve that may necessitate this surgical repair include:

• When the mitral valve has hardened due to calcium buildup in what is called calcification. This prevents blood from moving forward.
• When the mitral valve is too loose. This causes the blood to flow backwards.
• When the flaps of the valve don’t close properly between heartbeats in what is called regurgitation. This causes the blood to leak backwards into the atrium.
• When the flaps in the mitral valve stiffen or even fuse in what is called stenosis. This decreases blood flow and narrows the valve.

How is a minimally invasive mitral valve repair performed?

A surgeon can repair the mitral valve by tightening the flaps with a ring (an annuloplasty), securing the flaps, patching any holes, removing any excess tissue, separating flaps if they have fused, or widening a narrow valve opening using a balloon at the end of a catheter (valvuloplasty).

Before the procedure, the patient is put under a general anaesthetic. The surgery can be performed in one of two ways:

• The surgeon makes one incision around 6cm wide along the ribs. An endoscope, which is a long thin instrument with a camera on the end, and other tools are inserted through the incision so that the surgeon can access the mitral valve and perform the repair.
• The surgeon makes a few small holes in the chest, through which the tools and endoscope are inserted to perform the repair. If the surgery is with robotic assistance, this will be the method used.

The surgery tends to take 4-5 hours. In some cases, the mitral valve needs to be replaced, and the replacement valve can be a mechanical valve or one made of cow, pig, or human heart tissue.

What happens after minimally invasive mitral valve repair?

Minimally invasive techniques are preferable to open-heart techniques, as the wounds are easier to recover from, resulting in a shorter hospital, a quicker recovery time, and less pain after the procedure.

After the procedure, patients will spend a week in the hospital, and will possibly be fitted with drainage tubes in the chest to prevent fluid build-up. It will take a couple of months before patients are fully recovered, during which they should avoid heavy lifting and strenuous activities; doctors’ advice will differ for each patient depending on the type of procedure and their physical condition.

Patients with a mechanical mitral valve replacement will need to be on blood thinners for life to prevent clots, and those with biological replacements may need another one after some years due to tissues breaking down.

Patients are encouraged to complete a cardiac rehabilitation programme to train their heart and increase their activity safely over time, as well as educate patients about how to best look after their newly-repaired heart.

If you are having heart issues, you can arrange an appointment with Mr Albanese today on  his Top Doctors profile.