Mitral Valve Repair and Replacement

Introduction

Mitral valve repair and replacement are surgical procedures used to treat mitral valve disorders, such as mitral regurgitation or mitral stenosis. The mitral valve is a vital structure in the heart that separates the left atrium and left ventricle, allowing blood to flow from the atrium into the ventricle while preventing backflow.

Mitral Valve Repair

Mitral valve repair is a surgical procedure that aims to preserve the native mitral valve and restore its function. The goal of repair is to correct the underlying cause of mitral regurgitation or stenosis, such as leaflet prolapse, chordae tendineae rupture, or annular dilation.

• Techniques: Various techniques are used in mitral valve repair, including:
  • Annuloplasty: repairing the mitral valve annulus using a prosthetic ring
  • Leaflet repair: repairing or replacing damaged leaflets
  • Chordal transfer: transferring chordae tendineae from one leaflet to another
• Benefits: Mitral valve repair has several benefits, including:
  • Preservation of native valve function
  • Reduced risk of complications associated with prosthetic valves
  • Lower risk of endocarditis
  • Better preservation of left ventricular function

Mitral Valve Replacement

Mitral valve replacement is a surgical procedure that involves removing the diseased mitral valve and replacing it with a prosthetic valve. This procedure is typically performed when the native valve is severely damaged or cannot be repaired.

• Types of prosthetic valves:
  • Mechanical valves: made of metal or ceramic materials, requiring lifelong anticoagulation therapy
  • Bioprosthetic valves: made from animal tissue, such as porcine or bovine pericardium, with a limited lifespan (typically 10-15 years)
• Benefits and risks:
  • Benefits: effective in treating mitral valve disease, improved symptoms and quality of life
  • Risks: prosthetic valve failure, anticoagulation-related complications, endocarditis, and reoperation

Surgical Approaches

Mitral valve repair and replacement can be performed using various surgical approaches, including:

• Median sternotomy: a traditional open-chest approach
• Minimally invasive surgery: smaller incisions, reduced tissue damage, and faster recovery
• Robotic-assisted surgery: enhanced visualization, precision, and dexterity using robotic instruments

Postoperative Care and Recovery

After mitral valve repair or replacement, patients typically require:

• Intensive care unit (ICU) stay: close monitoring of vital signs, cardiac function, and potential complications
• Anticoagulation therapy: for patients with mechanical valves or those at high risk of thromboembolism
• Cardiac rehabilitation: a supervised program to improve cardiovascular health and functional capacity
• Follow-up care: regular appointments with the cardiologist and surgeon to monitor valve function, adjust medications, and address any concerns

Complications and Risks

Mitral valve repair and replacement carry potential risks and complications, including:

• Prosthetic valve failure
• Endocarditis
• Stroke or transient ischemic attack (TIA)
• Bleeding or hemorrhage
• Infection or sepsis
• Respiratory failure
• Cardiac arrhythmias
• Reoperation

Conclusion

Mitral valve repair and replacement are effective surgical procedures for treating mitral valve disorders. While both techniques have benefits and risks, the choice of procedure depends on individual patient factors, such as valve anatomy, disease severity, and overall health status.