Mitral regurgitation surgery procedure


 * Associate Editor-In-Chief: Mohammed A. Sbeih, M.D. [mailto:msbeih@perfuse.org]

Procedure
The Procedure can be done either by the traditional open heart surgery or by the Minimally invasive surgery. Before the surgery, the patient will receive general anesthesia. This will make the patient asleep and pain-free during the entire procedure.


 * In the traditional open heart surgery:


 * The surgeon will make a 10-inch-long cut in the middle of the chest (sternum).
 * Next, the surgeon will separate the breastbone (sternum) to be able to see the heart.
 * Most people are connected to a heart-lung bypass machine or bypass pump. The heart is stopped while the patient is connected to this machine. This machine does the work of the heart while the heart is stopped.
 * A small cut is made in the left side of the heart so the surgeon can repair or replace the mitral valve.


 * In minimally invasive mitral valve surgery; there are several different ways to perform the procedure:


 * The heart surgeon may make a 2-inch to 3-inch-long cut in the right part of your chest near the sternum (breastbone). Muscles in the area will be divided so the surgeon can reach the heart. A small cut is made in the left side of the heart so the surgeon can repair or replace the mitral valve.
 * In Endoscopic surgery, the surgeon makes one to four small holes in the chest, then he or she uses special instruments and a camera to do the surgery.
 * For Robotically-assisted valve surgery, the surgeon makes two to four tiny cuts (about a ½ to a ¾ inch) in the chest. The surgeon uses a special computer to control robotic arms during the surgery. The surgeon sees a three-dimensional view of the heart and mitral valve on the computer. This method is very precise.

The patient may or may not need to be on a heart-lung machine for these types of surgery, but if not, the heart rate will be slowed by medicine or a mechanical device.

If the surgeon can repair the mitral valve, the patient may have:
 * Ring annuloplasty: The surgeon repairs the ring-like part around the valve by sewing a ring of metal, cloth, or tissue around the valve.
 * Valve repair: The surgeon trims, shapes, or rebuilds one or more of the three leaflets of the valve. The leaflets are flaps that open and close the valve.

If the mitral valve is too damaged, the patient will need a new valve. This is called Replacement surgery. The surgeon will remove the mitral valve and sew a new one into place. There are two types of valves:

1. Mechanical which is made of man-made (synthetic) materials, such as a metal like titanium. These valves last the longest, but the patient will need to take blood-thinning medicine, such as warfarin (Coumadin) or aspirin, for the rest of his or her life.

2. Biological which made of human or animal tissue. These valves last 10 to 12 years, but the patient may not need to take blood thinners for life.

Once the new or repaired valve is working, the surgeon will: The patient may have a temporary pacemaker connected to the heart until his or her natural heart rhythm returns.
 * Close the heart and take you off the heart-lung machine.
 * Place catheters (tubes) around the heart to drain fluids that build up.
 * Close the sternum with stainless steel wires. It will take about 6 weeks for the bone to heal. The wires will stay inside the body.

The surgeon may also perform coronary artery bypass surgery at the same time, if needed.