What is Open Mitral Valve Repair

Open mitral valve repair is a type of surgery to fix problems with the mitral valve. This is the valve between the upper chamber (atrium) and the lower chamber (ventricle) on the left side of the heart.

The mitral valve has two flaps that open and close so that blood can move from the atrium to the ventricle. The valve allows blood to flow in only one direction.

You may need this surgery if your mitral valve is not working properly. The valve may not open far enough, not close all the way, or have other problems. Surgery may also be recommended if the valve is infected, if you have a weak heart muscle, or if you have symptoms from your mitral valve leaking.

“Open” means the surgery is done through a large incision in the chest. The procedure may involve:

• Reshaping the valve.
• Removing tissue.
• Fixing holes or tears.
• Fixing the flaps.
• Separating the flaps, if they are joined together (fused).

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 medicines.
• 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.
• Bleeding.
• Allergic reactions to medicines.
• Damage to other structures or organs.
• Blood clots.
• Breathing problems.
• Heart attack.
• Stroke.
• Kidney problems.
• Irregular heartbeat.
• Failing or failure of a clip or device that is used to repair the valve.

What happens before the procedure?

Eating and drinking restrictions

Follow instructions from your health care provider about eating and drinking restrictions before surgery.

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 over-the-counter medicines, vitamins, herbs, and supplements.
  • Taking medicines such as aspirin and ibuprofen. These medicines can thin your blood. Do not take these medicines unless your health care provider tells you to take them.
• You may need to take antibiotic medicine. If so, take your antibiotic as told by your health care provider. Do not stop taking the antibiotic even if you start to feel better.

General instructions

• 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.
• You may be asked to shower with a germ-killing soap.
• Ask your health care provider how your surgical site will be marked or identified.
• Plan to have a responsible adult care for you for at least 24 hours after you leave the hospital or clinic. This is important.

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 will be inserted into one of your veins.
• You will be given one or more of the following:
  • A medicine to help you relax (sedative).
  • A medicine to make you fall asleep (general anesthetic).
• A breathing tube may be placed in your throat and connected to a machine (ventilator) to help you breathe.
• An incision will be made in your chest, over your heart, through your breastbone.
• Muscles will be moved out of the way to reach your heart.
• Your heart may be stopped with medicine, and a tube may be placed in your heart and connected to a machine that keeps your blood pumping and does the work of your heart and lungs (heart-lung machine).
• Your mitral valve will be repaired as needed. A clip or device may be used to reshape the valve, fix holes or tears, or fix the flaps. The clip or device may stay in your heart.
• After the repair, your heart may start working on its own, or you may need electric shocks to start your heart.
• If you are connected to a heart-lung machine, it will be disconnected and removed.
• You may continue to have a breathing tube connected to a ventilator, or the tube may be removed. This will depend on how well you are breathing.
• Small tubes may be placed to drain fluid from the surgical area.
• A small, thin tube (catheter) may be placed to drain urine from your bladder.
• Your incision will be closed with stitches (sutures). A bandage (dressing) may be placed over the incision.

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 some pain. You will be given medicine as needed.
• You may continue to receive fluids and medicines through an IV.
• You may continue to use a breathing tube and ventilator. You may be given oxygen through a device or tube that goes in the nostrils (nasal prongs).
• You may continue to have a catheter draining your urine and tubes draining fluid from the surgical area.

Summary

• Mitral valve repair is a type of surgery to fix the valve between the upper chamber (atrium) and the lower chamber (ventricle) on the left side of the heart.
• Follow instructions from your health care provider about eating and drinking restrictions before the procedure.
• Repairing the mitral valve may include reshaping it, fixing it, removing tissue, or fixing the flaps.

Open Mitral Valve Repair, 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.
• Bruising and soreness in the chest.
• Scarring.
• Fatigue.

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:

• Redness, swelling, or pain.
  • Fluid or blood.
  • Warmth.
  • Pus or a bad smell.

Activity

• Do not lift anything that is heavier than 10 lb (4.5 kg), or the limit that you are told, until your health care provider says that it is safe. Avoid pushing and pulling motions.
• Do not drive or use heavy machinery while taking prescription pain medicine. Ask your health care provider when it is safe for you to drive.
• Avoid activity that requires a lot of energy, such as exercise or sports. Ask your health care provider what activities are safe for you and when you may return to your normal activities.
• Avoid sexual activity until your health care provider says this is safe.
• Participate in a formal exercise program (cardiac rehabilitation) following surgery.

Medicines

• Take over-the-counter and prescription medicines only as told by your health care provider. You may need to take medicines to prevent blood clots.
• If you were prescribed an antibiotic medicine, take it as told by your health care provider. Do not stop taking the antibiotic even if you start to feel better.

Lifestyle

• 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.
• Avoid drinking alcohol.

General instructions

• Do not take baths, swim, shower, or use a hot tub until your health care provider approves. You may only be allowed to take sponge baths.
• Do not remove your drains or tubes until your health care provider tells you to do that. Follow instructions from your health care provider about how to take care of your drains and tubes.
• Drink enough fluid to keep your urine pale yellow.
• Follow instructions from your health care provider about eating or drinking restrictions. You may need to eat a low-salt (low-sodium) and low-fat diet to prevent heart problems.
• Wear compression stockings as told by your health care provider. These stockings help to prevent blood clots and reduce swelling in your legs.
• Weigh yourself daily. Keep track of your weight so you can notice any changes.
• Keep all follow-up visits as told by your health care provider. This is important.

Contact a health care provider if:

• You have severe pain that does not get better with medicine.
• You have redness, swelling, or pain around your incision.
• Your incision feels warm to the touch.
• You have pus or a bad smell coming from your incision.
• You have fluid or blood coming from your incision.
• You have a fever.
• You gain weight rapidly.

Get help right away if:

• You have chest pain.
• You have trouble breathing.
• You feel dizzy or you faint.
• You have any symptoms of stroke. “BE FAST” is an easy way to remember the main warning signs of stroke:
  • B – Balance. Signs are dizziness, sudden trouble walking, or loss of balance.
  • E – Eyes. Signs are trouble seeing or a sudden change in vision.
  • F – Face. Signs are sudden weakness or numbness of the face, or the face or eyelid drooping on one side.
  • A – Arms. Signs are weakness or numbness in an arm. This happens suddenly and usually on one side of the body.
  • S – Speech. Signs are sudden trouble speaking, slurred speech, or trouble understanding what people say.
  • T – Time. Time to call emergency services. Write down what time symptoms started.
• You have other signs of stroke, such as:
  • A sudden, severe headache with no known cause.
  • Nausea or vomiting.
  • Seizure.

These symptoms may represent a serious problem that is an emergency. Do not wait to see if the symptoms will go away. Get medical help right away. Call your local emergency services (911 in the U.S.). Do not drive yourself to the hospital.

Summary

• After this procedure, it is common to have pain and soreness in the chest area.
• Check your incision area every day for signs of infection, such as redness, swelling, or pain.
• Take over-the-counter and prescription medicines only as told by your health care provider. You may need to take medicines to prevent blood clots.