What is Mitral Valve Replacement

Mitral valve replacement is surgery to replace the mitral valve with an artificial (prosthetic) valve.

You may need this procedure if your mitral valve is too damaged to repair, such as from rheumatic disease. Three types of prosthetic valves are available:

• Mechanical valves made entirely from prosthetic materials.
• Donor valves from human donors. These are used only in certain situations.
• Biological valves made from animal tissues.

There are two types of mitral valve replacement surgeries:

• Traditional mitral valve replacement surgery. This is done with a large incision in the chest.
• Minimally invasive mitral valve replacement surgery. This is done with a smaller incision in the chest.

You and your surgeon will decide which type of valve is best for you and which type of surgery you will have.

Tell a health care provider about:

• Any allergies you have.
• All medicines you are taking, including vitamins, herbs, eye drops, creams, and over-the-counter medicines.
• Any problems you or family members have had with anesthetic medicine.
• Any blood disorders you have.
• Any surgeries you have had.
• Any medical conditions you have.
• Whether you are pregnant or may be pregnant.

What are the risks?

Generally, this is a safe procedure. However, problems may occur, including:

• Infection of the new valve.
• Bleeding.
• Allergic reactions to medicines.
• Damage to other structures or organs.
• Blood clotting caused by the new valve. Replacement with a mechanical valve requires lifelong treatment with medicine to prevent blood clots.
• Valve failure.

What happens before the procedure?

Medicines

• Ask your health care provider about:
  • Changing or stopping your regular medicines. This is especially important if you are taking diabetes medicines or blood thinners.
  • Taking medicines such as aspirin and ibuprofen. These medicines can thin your blood. Do not take these medicines before your procedure if your health care provider instructs you not to.
• You may be given antibiotic medicine to help prevent infection.

Staying hydrated

Follow instructions from your health care provider about hydration, which may include:

• Up to 2 hours before the procedure – you may continue to drink clear liquids, such as water, clear fruit juice, black coffee, and plain tea.

Eating and drinking restrictions

Follow instructions from your health care provider about eating and drinking, which may include:

• 8 hours before the procedure – stop eating heavy meals or foods such as meat, fried foods, or fatty foods.
• 6 hours before the procedure – stop eating light meals or foods, such as toast or cereal.
• 6 hours before the procedure – stop drinking milk or drinks that contain milk.
• 2 hours before the procedure – stop drinking clear liquids.

General instructions

• Do not use any products that contain nicotine or tobacco for as long as possible before your procedure. This includes cigarettes and e-cigarettes. If you need help quitting, ask your health care provider.
• Ask your health care provider how your surgical site will be marked or identified.
• You may be asked to shower with a germ-killing soap.
• You may have tests, such as:
  • Electrocardiogram (ECG). This test records electrical activity in the heart.
  • An echocardiogram. This test creates ultrasound images of the heart that allow your health care provider to see how the heart valves work while your heart is beating.
• You may have a blood or urine sample taken.
• Plan to have someone take you home from the hospital or clinic.
• If you will be going home right after the procedure, plan to have someone with you for 24 hours.

What happens during the procedure?

• To lower your risk of infection:
  • Your health care team will wash or sanitize their hands.
  • Your skin will be washed with soap.
  • Hair may be removed from the surgical area.
• An IV tube will be inserted into one of your veins.
• You will be given a medicine to make you fall asleep (general anesthetic).
• You will be placed on a machine that provides oxygen to your blood while the heart is undergoing surgery (heart-lung bypass machine).
• If you are having traditional surgery, a large incision will be made in your chest. If you are having minimally invasive surgery, a smaller incision will be made in your chest.
• Your heart may be cooled to slow or stop the heartbeat.
• Your damaged mitral valve will be removed, and the prosthetic valve will be sewn into place.
• Your incision may be closed with stitches (sutures) and covered with a bandage (dressing).

The procedure may vary among health care providers and hospitals.

What happens after the procedure?

• Your blood pressure, heart rate, breathing rate, and blood oxygen level will be monitored until the medicines you were given have worn off.
• You may have to wear compression stockings. These stockings help to prevent blood clots and reduce swelling in your legs.
• You may have some chest pain. You will be given pain medicine as needed.
• Do not drive until your health care provider approves.

Mitral Valve Replacement, Care After

This sheet gives you information about how to care for yourself after your procedure. Your health care provider may also give you more specific instructions. If you have problems or questions, contact your health care provider.

What can I expect after the procedure?

After the procedure, it is common to have:

• Pain at the incision area that may last for several weeks.

Follow these instructions at home:

Incision care

• Follow instructions from your health care provider about how to take care of your incision. Make sure you:
  • Wash your hands with soap and water before you change your bandage (dressing). If soap and water are not available, use hand sanitizer.
  • Change your dressing as told by your health care provider.
  • Leave stitches (sutures), skin glue, or adhesive strips in place. These skin closures may need to stay in place for 2 weeks or longer. If adhesive strip edges start to loosen and curl up, you may trim the loose edges. Do not remove adhesive strips completely unless your health care provider tells you to do that.
• Check your incision area every day for signs of infection. Check for:
  • More redness, swelling, or pain.
  • More fluid or blood.
  • Warmth.
  • Pus or a bad smell.
• Do not apply powder or lotion to the area.

Driving

• Do not drive until your health care provider approves.
• Do not drive or use heavy machinery while taking prescription pain medicines.

Bathing

• Do not take baths, swim, or use a hot tub for 2–4 weeks after surgery, or until your health care provider approves. Ask your health care provider if you may take showers.
• To wash the incision site, gently wash with soap and water and pat the area dry with a clean towel. Do not rub the incision area. That may cause bleeding.

Activity

• Rest as told by your health care provider. Ask your health care provider when you can resume normal activities, including sexual activity.
• Avoid the following activities for 6–8 weeks, or as long as directed:
  • Lifting anything that is heavier than 10 lb (4.5 kg), or the limit that your health care provider tells you.
  • Pushing or pulling things with your arms.
• Avoid climbing stairs and using the handrail to pull yourself up for the first 2–3 weeks after surgery.
• Avoid airplane travel for 4–6 weeks, or as long as directed.
• Avoid sitting for long periods of time and crossing your legs. Get up and move around at least once every 1–2 hours.
• If you are taking blood thinners (anticoagulants), avoid activities that have a high risk of injury. Ask your health care provider what activities are safe for you.

Lifestyle

• Limit alcohol intake to no more than 1 drink a day for nonpregnant women and 2 drinks a day for men. One drink equals 12 oz of beer, 5 oz of wine, or 1½ oz of hard liquor.
• Do not use any products that contain nicotine or tobacco, such as cigarettes and e-cigarettes. If you need help quitting, ask your health care provider.

General instructions

• Take your temperature every day and weigh yourself every morning for the first 7 days after surgery. Write your temperatures and weight down and take this record with you to any follow-up visits.
• Take over-the-counter and prescription medicines only as told by your health care provider.
• To prevent or treat constipation while you are taking prescription pain medicine, your health care provider may recommend that you:
  • Drink enough fluid to keep your urine clear or pale yellow.
  • Take over-the-counter or prescription medicines.
  • Eat foods that are high in fiber, such as fresh fruits and vegetables, whole grains, and beans.
  • Limit foods that are high in fat and processed sugars, such as fried and sweet foods.
• Follow instructions from your health care provider about eating or drinking restrictions.
• Wear compression stockings for at least 2 weeks, or as long as told by your health care provider. These stockings help to prevent blood clots and reduce swelling in your legs. If your ankles are swollen after 2 weeks, continue to wear the stockings.
• Keep all follow-up visits as told by your health care provider. This is important.

Contact a health care provider if:

• You develop a skin rash.
• Your weight is increasing each day over 2–3 days.
• You gain 2 lb (1 kg) or more in a single day.
• You have a fever.

Get help right away if:

• You develop chest pain that feels different from the pain caused by your incision.
• You develop shortness of breath or difficulty breathing.
• You have more redness, swelling, or pain around your incision.
• You have more fluid or blood coming from your incision.
• Your incision feels warm to the touch.
• You have pus or a bad smell coming from your incision.
• You feel light-headed.