Mitral Valve Surgery

In cases that occur as a result of mitral valve diseases, such as heart enlargement, increased lung blood pressure, or as a result of too many complaints, the common point of all of them is the need for intervention. If all these criteria are met, the patient's heart valve can be repaired or replaced with a minimally invasive technique, especially by entering from a 4-centimeter area under the arm. Regardless of whether there is stenosis, leakage or insufficiency in the mitral valve, with timely intervention, the heart stops growing, the progression of lung blood pressure decreases and it can return to normal within 6 months and 1 year. Heart rhythm disorders slow down, become regulated, and the patient's complaints decrease day by day.

Surgery Duration
1-2 hours
Recovery Time
1-2 Weeks
Discharge Time
3 or 4 days
minimally invasive surgery
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To whom is Mitral Valve Surgery performed?

Its application, especially in patients without lung problems, not only reduces complications but also reduces the risk of heart surgery in case a second surgery is required later in life. Patients with mitral valve repair can easily undergo open heart surgery when valve replacement is required after 15-20 years. This is another advantage that extends life.

How is Mitral Valve Surgery Performed?

The mitral valve, the valve between the left atrium and the left ventricle in the large circulation, which is the circulation of the left side of the heart, that is, the clean blood... It is the valve most affected by rheumatic diseases. After rheumatic inflammations, the valve structure may thicken and its movements are impaired. In advanced stages, valve stenosis and insufficiency occur. The most obvious symptom is shortness of breath when climbing stairs. Since it progresses insidiously, surgery should be performed in time before heart failure occurs.

Mitral valve repair and replacement surgeries are routinely performed in the old open-heart surgery style by making a 35-40 cm incision in the pelvis bone, and minimally invasive techniques have been developed in the last 30 years due to the high number of complications and the delay in bone union. The practice of removing the mitral valve by entering the heart and replacing it with a new valve for 50-60 years has provided great experience and allowed the development of new types of heart valves. Today, the successful application of minimally invasive (armpit minithoracotomy) techniques and advanced bileaflet (double-leaflet) metal and biological heart valves have greatly increased the success rate in these surgeries. The surgeries performed extend life by as high as 30-40 years.

Mitral valve repair and replacement surgeries It can be done with minimally invasive (right armpit) techniques.

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Prof. Dr. Yavuz Beşoğul

We have demonstrated the many benefits of this technique, which we first started in 1997 and published international scientific studies in 1999, 2001, 2004. Among these benefits; The patient's early return to daily life. It is especially preferred by physically working patients. Other benefits include patients being discharged early, not having to protect their chest, being able to sleep on their side, having a very low risk of infection, and being able to drive a vehicle.

The benefits during the hospital period are; Complications such as bleeding and infection are few, the intensive care period does not exceed 24 hours, and the hospital stay is 4-5 days. The only disadvantage for the patient is that the early pain is slightly more than that of routine heart surgery. The reason is that the outer membrane of the lung is sensitive to pain. But after 8-10 hours, there is no pain. In heart surgery performed with this technique, the chest is entered through a right armpit minithoracotomy and the mitral heart valve is accessed by connecting it to the heart-lung pump. In heart valves that are not excessively calcified, expansion and/or repair can be performed, or the mitral valve can be removed and replaced with a metal or biological valve.

Diagnosis of Mitral Valve Disease

The test that should be performed in the definitive diagnosis of mitral valve disease is an ultrasound of the heart. echocardiography is to be done. As a result, valve leakage or stenosis may occur. Or, both stenosis and leakage may be detected. Regardless of the situation that occurs as a result of this, such as an enlarged heart, increased lung blood pressure, or a large number of complaints, the common point of all of them is the need for intervention.

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Mitral Valve Diseases and Mitral Valve Change

Prof. Dr. Yavuz Beşoğul

The mitral valve, one of the four valves in the heart, located between the left atrium and left ventricle, is the valve that ensures that the blood from the lungs, cleaned with oxygen, passes from the left atrium to the left ventricle and that the blood does not leak back. Problems such as stenosis, leakage and insufficiency may occur in the mitral valve. Depending on the condition of the mitral valve problem, mitral valve repair or mitral valve replacement are among the treatment options.

Mitral Valve Repair Surgery

In order to eliminate the problem in the patient's mitral valve, if the condition of the valve is suitable, repair should be preferred first. Because it is better for the patient to continue his life with his own valve than to have it replaced with an artificial heart valve. In cases where mitral valve disorders are not severe, the mitral valve can be repaired and treated. In order for mitral valve repair to be performed, the heart valve leaflets must be regular, there must be no stenosis with heart valve leakage, there must be no clot or roughness on the valve, the valve leaflets must be able to approach each other easily, or the valve leaflets must not leak backwards when the stenosis can be opened.

 

Mitral Valve Replacement Surgery

Mitral valve replacement is the replacement of the mitral valve with biological or mechanical artificial valves, which is applied in cases where the patient's mitral valve stenosis and insufficiency problems cannot be resolved by repair. It may be necessary to replace the valve in cases such as severe regurgitation or severe stenosis of the heart valves, sometimes both together, severe calcification of the valve, clot in front of the valve, clot inside the heart, or heart rhythm disturbance. Mitral valve insufficiency, severe mitral valve stenosis, atrial fibrillation, and sudden rupture of the heart valve are among these conditions.

Is Surgery the First Response to Patients with Aortic Valve Stenosis or Insufficiency?

The narrowing of the aortic valve makes it difficult for blood to flow healthily throughout the body. Aortic insufficiency means blood comes from the aorta towards the heart. In some cases, patients have both stenosis and insufficiency in the aortic valve. In order to decide on the intervention to be applied in aortic stenosis or aortic insufficiency, the patient's complaints should be taken into consideration first. Aortic valve disease, stenosis or insufficiency reaching critical levels affects the decision for surgery.

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Things to Consider After Mitral Valve Surgery

One of the most important issues after mitral valve replacement is that patients use blood thinners regularly as recommended by the physician. While the use of blood thinners for biological valve replacement is 3 months, patients must use blood thinners for life in mechanical valve replacement. In addition, it is extremely important to protect the patient from infections. In cases such as surgical interventions that may be due to another disease, it is important for the patient to contact the heart doctor and take preventive measures against infection. However, the patient must undergo regular medical check-ups in which the heart and heart valves are monitored.

Early diagnosis is very important in the treatment of mitral valve diseases. Mitral valve problem detected at an early stage can be treated with mitral valve repair without the need for valve replacement, if the necessary fitness is available.

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Prof. Dr. Academic Statements from Yavuz Beşoğul about Mitral Valve Surgery

Mitral valve surgery involves the repair or replacement of the mitral valve itself or the ring. Thanks to many years of experience in heart valve surgeries, artificial valves have been developed and have contributed to the development of surgical techniques. The most preferred metallic heart valves today have a bi-leaflet carbometal structure and are long-lasting, although they require anticoagulants. In addition, biological valves made from bovine or porcine pericardium have been developed for those who cannot use anticoagulants, such as the elderly or patients considering pregnancy. Mitral valve replacement or repair has been performed by sternotomy for many years. Due to the complications of sternotomy, mitral valve surgeries began to be performed with anterolateral thoracotomy in the world in the 1990s, and access incisions gradually became smaller.

In 1997, we first started performing our surgeries by converting them to subaxillary incision in our country and contributed to the national and international literature in series. In fact, although there is no difference in the surgical technique, the entry technique has proven to be advantageous from bleeding to infection and early return to daily life. It reduces complications, especially in patients with diabetes, rib cage disorders, kidney failure and obesity. In addition, the small size of the incision and its location on the side are also important from a cosmetic perspective.

On the other hand, the entrance site of the surgery provides excellent visibility and access, especially in terms of the exposure of the mitral valve. This is another factor that reduces complications. If both mitral and aortic valve replacement is required due to different entrance elevation gaps Aortic and mitral valve (double valve) surgery should not be performed with this technique. In such cases, a frontal incision, that is, ministernotomy, is more useful and there is no entry site complication.

Mitral Valve Surgery Technique

The patient is placed on the left side of the chest under double lumen intubation and general anesthesia; That is, an anterolateral thoracotomy position is given with the chest on the right side. A vertical 6 cm incision is made on the intersection of the subaxillary line and the right breast line, pectoralis major and pectoralis minor. without cutting the muscles It is dissected and a retractor is placed. 4. The thorax is entered through the intercostal space and right lung ventilation is turned off or, if not tolerated, the tidal volume is reduced. The pericardium opens and its leaves hang on the chest wall. Aorta, right and left atrium are clearly seen. After returning the aorta with the pedicle, it is suspended and the aorta, right auricle, and right atrium are easily cannulated. The patient is connected to the heart-lung pump, extra-corporeal circulation is transferred, ventilation is stopped and an x-clamp is placed on the aorta. Cardiac arrest is achieved by applying cold blood cardioplegia and topical cold saline. The left atrium opens and the image of the mitral valve is clear.

Postoperative

After the repair or replacement is made, the left atrium is closed. The patient is warmed, the heart is defibrillated if necessary, and after starting, the pump flow is gradually reduced and stopped. The heart is easily decannulated. After bleeding control, a single chest drain is placed in the thorax (the location of the drain is important to avoid pain), the ribs are brought closer, and the muscles, subcutaneous and skin are closed properly. Postoperative follow-up is the same.

While this intervention technique can be applied to any patient, it is only In some cases it should not be preferred. These :

  • Those with advanced lung problems
  • Those over 75 years of age,
  • Double valve replacement (Aortic and Mitral) required,
  • It should never be applied to patients requiring aortic valve surgery for the second time.

In addition, it is an ideal method for second and third mitral valve surgeries.

Frequently Asked Questions

How Many Hours Does Mitral Valve Surgery Take?

Mitral valve surgery is an operation that usually takes 2-3 hours. The duration of the surgery may also vary depending on heart health status and other interventions to be performed on the heart. The duration of mitral valve repair operations and valve replacement surgeries is also different.

What are the degrees of Mitral Valve Insufficiency?

Mitral valve insufficiency, one of the most common problems, is divided into 4 degrees. While 1st and 2nd degree insufficiency is a problem that needs to be kept under control; Patients with level 3 and 4 deficiency problems need to be treated.

How to Perform Minimally Invasive Mitral Valve Surgery?

Minimally invasive surgery performed under the armpit or under the breast with a few centimeter interventions is superior to open heart surgery in terms of patient comfort and surgical risks. Discharge and recovery time is shorter after mitral valve surgery, which can be performed from the lower or lateral part of the breast.

How is Mitral Valve Repair Done?

In cases of mitral valve insufficiency or stenosis, valve repair can be performed instead of heart valve replacement. If the damage to the patient's mitral valve is not too advanced, the patient can be treated by repairing the heart valve without installing a new valve.

How is Mitral Valve Replacement Done?

In cases where the damage to the mitral valve is beyond repair, a new valve must be implanted in the patient. The patient's heart valve can be replaced using a natural heart valve taken from animals such as cattle or pigs or an artificial heart valve made of metal. Mechanical heart valves are longer lasting than biological valves, but the patient must use blood thinners for life. Since biological heart valves are short-lived and require the patient to undergo surgery every 2-3 years, surgeons usually perform the surgery with mechanical valves.

What is the Recovery Time After Mitral Valve Surgery?

After minimally invasive mitral valve surgery, patients are discharged after 3-4 days. The average time to return to daily life after surgery is 1-2 weeks. Patients need less dressing and can sleep in any position they wish after surgery. Additionally, patients do not need to protect the chest area and there is less pain or soreness.

Causes of Mitral Valve Disease?
Mitral valve diseases can occur in 3 ways.
  • The first and most common of these is rheumatic. In other words, the mechanism developed by the body against the microbe caused by the throat inflammation that the patient was born with subsequently damages the heart valve or rheumatic joints by affecting them.
  • Another reason is mitral valve disorder from childhood.
  • The third reason is the deterioration of nutrition in the area where the valve is located and the insufficiency of the heart valve as a result of a heart attack at older ages.
Causes of Mitral Valve Disease?

Although there are not many symptoms in the early or middle stages of the disease, the patient does not have many complaints. If the disease is too advanced, heart failure occurs in the patient with Mitral Valve Insufficiency as the left ventricle works more intensively and becomes more tired. It manifests itself in symptoms along with this event.

Symptoms of Mitral Valve disease include:

  • Shortness of breath
  • Palpitation
  • arrhythmia
  • Heart pounding like it's fluttering

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