Mitral valve surgery - minimally invasive Health Article

Definition

Blood that flows between different chambers of your heart must flow through a valve. This valve is called the mitral valve. It opens up enough so blood can flow from one chamber of your heart (left atria) to the next chamber (left ventricle). It then closes, keeping blood from flowing backwards.

Mitral valve surgery is surgery to either repair or replace the mitral valve in your heart.

Minimally invasive mitral valve surgery is done through much smaller incisions (cuts) than the large incision needed for open surgery.

See also: Mitral valve surgery - open

Alternative Names

Mitral valve repair - right mini-thoracotomy; Mitral valve repair - partial upper sternotomy; Robotically-assisted, endoscopic valve repair, Percutaneous mitral valvuloplasty

Description

Before your surgery you will receive general anesthesia. This will make you unconscious and unable to feel pain.

There are several different ways to perform minimally invasive mitral valve surgery.

• Your heart surgeon may make a 2-inch to 3-inch-long incision (cut) in the right part of your chest near the sternum (breastbone). Muscles in the area will be divided so your surgeon can reach the heart. A small cut is made in the left side of your heart so the surgeon can repair or replace the mitral valve.
• In endoscopic surgery, your surgeon makes 1 to 4 small holes in your chest. Then your surgeon uses special instruments and a camera to do the surgery.
• For robotically-assisted valve surgery, the surgeon makes 2 to 4 tiny cuts (about ½ to ¾ inch) in your chest. The surgeon uses a special computer to control robotic arms during the surgery. The surgeon sees a 3-dimensional view of the heart and aortic valve on the computer. This method is very precise.

You will not need to be on a heart-lung machine for these types of surgery, but your heart rate will be slowed by medicine or a mechanical device.

If your surgeon can repair your aortic valve, you may have:

• Ring annuloplasty -- The surgeon repairs the ring-like part around the valve by sewing a ring of metal, cloth, or tissue around the valve.
• Valve repair -- The surgeon trims, shapes, or rebuilds 1 or more of the 3 leaflets of the valve. The leaflets are flaps that open and close the valve.

If your mitral valve is too damaged, you will need a new valve. This is called replacement surgery. Your surgeon will remove your mitral valve and sew a new one into place. There are two main types of new valves:

• Mechanical -- made of man-made materials, such as cloth, metal, or ceramic. These valves last the longest, but you will need to take blood-thinning medicine, such as warfarin (Coumadin) or aspirin, for the rest of your life.
• Biological -- made of human or animal tissue. These valves last 12 to 15 years, but you may not need to take blood thinners for life.

The surgery may take 1 to 3 hours.

This surgery can also be done through a groin artery, with no incisions on your chest. The doctor sends a catheter (flexible tube) with a balloon attached on the end. The balloon stretches the opening of the valve. This procedure is called percutaneous valvuloplasty.