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Mitral Valve Replacement – MVR

Mitral Valve Surgery

The mitral valve is located on the left side of the heart between the bottom and top chambers (ventricle and atrium, respectively). A faulty mitral valve can be repaired or replaced. The selection of surgery will depend on individual case. Indication for mitral valve surgery follows complex guidelines, summarized as:

  • In isolation, when there is severe damage to the valve, either obstruction (also called ‘stenosis’) or leakage (‘regurgitation’ or ‘insufficiency’)
  • When there is moderate damage to the valve and a combined cardiac surgery is necessary (e.g. CABG, aortic valve replacement)
  • Infection of the mitral valve

NOTE: Any artificial heart valve will obstruct and leak a little bit, which can cause a murmur. Native valves are haemodynamically perfect: no leak, no obstruction and no murmur.

The Surgery

Conventionally, the heart is accessed via a vertical incision and spreading of the breastbone (called ‘sternum’). Cardiopulmonary Bypass and cardiac preservation are then established.

The heart (specifically the top chamber or atrium) is opened and the valve is inspected. In cases where repair is possible, the faulty parts of the valve are fixed. Otherwise the valve is replaced with a prosthesis (tissue or mechanical valve). Care is taken to clear all debris, the atrium is closed and air is evacuated from the heart.

The blood supply to the heart is resumed and it starts to beat again. Sometimes, a small electric shock is used to re-establish normal rhythm. Finally, the heart takes over the circulation again and the heart-lung machine is disconnected.

Afterwards, the surgeon controls potential sites of bleeding and inserts chest drains. A temporary pacemaker wire is also inserted. Drains and wires are removed in ICU or ward when no longer required.

The breastbone is closed with stainless steel wires. They will remain in your bone and should not activate metal detectors.

Choice of Prosthetic Valve

There are 2 types of heart valve substitutes: tissue and mechanical prosthesis.

Mechanical valves don’t wear off, however require continuous and lifelong blood thinning with vitamin K antagonist (VKA), for example Warfarin, Marevan or Coumadin. VKA carries a yearly complication rate of about 1 to 2% per year. The need for re-operation of a mechanical valve is low.

Tissue valves do not necessarily need continuous blood thinning. Nevertheless, they wear off over time and will eventually require replacement.

The valve preference is individual. However, patient’s specific situations should be discussed with the surgeon so that a shared decision-making about the choice of valve type is achieved. This choice is influenced by several factors, including patient age and life-style; expected valve durability; avoidance of patient-prosthesis mismatch (when the size of the vale is too small for the size of the patient); the potential need for and timing of re-intervention; and the risks associated with long-term VKA anticoagulation after a mechanical valve replacement. Read more.

Commonly Associated Procedures with Mitral Valve Surgery

Left Atrial Appendage Exclusion

This very short procedure is not essential to mitral valve surgery. The left atrial appendage (LAApdx) is a ‘wind-sock’ part of the left atrium. It is now known that the vast majority of strokes are caused by a blood clot originated inside the LAApdx. The rationale for this procedure is to prevent future strokes. Exclusion of the LAApdx can be performed with direct suture or using a device and adds about 5 to 10 minutes to the procedure. It is not suitable to every patient.

Surgery for Atrial Fibrilation

Atrial fibrilation (AFib) is fluttering of the upper chambers of the heart (the atria). Although it is common and temporary after cardiac surgery, some patients have AFib before surgery. For these patients, a procedure to try and resume normal heart rhythm can be performed, although it is not an essential step. This was originally done with a series of incisions on both atria. Today, the incisions are replaced by tissue injury caused by either radiofrequency ablation (RFA) and/or cryoablation (Cryo). It adds about 20-30 minutes to the surgery and is not suitable to every patient.

Other Procedures:

Coronary Artery Bypass, Tricuspid Valve Surgery, Aortic Valve Surgery.

Alternatives to Conventional Mitral Valve Surgery

Mini-Mitral

Minimal Access Mitral valve surgery (Mini-mitral) is performed via a chest incision and a series of holes on the chest to support other instruments. The circulatory support by the heart-lung-machine is carried on via cannulation of the groin and/or neck vessels. It is not suitable to every patient.

MitraClipTM

The MitraClipTM is a catheter-based procedure, whereby a device, the clip, is used to hold the two leaflets of the mitral valve together. It is used to manage leaking valves and is inserted via the groin vessels. It is not suitable to every patient.

Associated Risks

Cardiac surgery is routinely performed all over the world. Australia ranks very well internationally, reflecting a high standard of care from both the operative setup and the hospital systems. As with any medical procedure, in a small number of cases, complications (adverse events) may occur.

The 5 major risks are bleeding and blood transfusion, mediastinitis (infection deeper to the chest bone), heart attack, stroke and even death. Other risks include need for pacemaker and organ failure (e.g. heart, lungs, kidneys).

The risk of infections, heart and lung problems and thrombosis increases with diabetes, obesity and smoking.

Please speak to your surgeon regarding your individual circumstances and any questions or doubts you may have.

For information about associated risks of cardiac surgery, please click here.


For an appointment or seeking a second opinion with Dr Provenzano, please contact:

Gold Coast Private Specialist Suites 14 Hill Street, Southport

P: (07) 5699 8258   F: (07) 5676 6784

Dr Sylvio Provenzano

MD, MSc, FRACS


Dr Sylvio Provenzano is an exam-qualified Cardiothoracic Surgeon by the Royal Australasian College of Surgeons (RACS). He specialises in cardiac, thoracic and congenital cardiac surgery.

Opening Hours

Gold Coast Private Specialist Suites


14 Hill Street, Southport 4215
9:00 – 16:00
 
Phone: (07) 5699 8258
Fax: (07) 5676 6784
 
Correspondence:
PO Box 809, Southport BC, Qld 4215