Mitral Valve Replacement Surgery

Mitral Valve Replacement Surgery

Mitral Valve Replacement Surgery 

Whenever the mitral valve is damaged and most of the times when it is leaky mitral valve or mitral  regurgitation in  those  circumstances we  replace  this entire mitral valve  structure with an artificial  valve. So that procedure is called mitral valve replacement. Mitral stenosis can be eminently treated  with a  balloon. Instead  of  replacing  the valve we  repair  the valve with a  balloon and open  up  the  valve so this procedure is called a balloon mitral valvotomy

In  this video Dr. C Raghu TAVR expert in India explains  to you all about Mitral Valve  replacement  surgery, When should a patient undergo it? What are the types of valves used in this surgery? When  this surgery cannot be performed? What are the options for the patients who are high risk for this  Mitral Valve replacement surgery?  

Whenever the mitral valve is damaged and most of the times when it is leaky mitral valve or mitral  regurgitation in  those  circumstances we  replace  this entire mitral valve  structure with an artificial  valve. So that procedure is called mitral valve replacement.  

As we have seen already there are two different types of mitral valve problems.  

One  is  a  narrowing  of  the  mitral  valve  also  called  as  mitral  stenosis.  So  when  the  valve  is  only  narrowed without any leaking of the valve, this type of mitral  stenosis can be eminently treated with  a balloon. Instead of replacing the valve we repair the valve with a balloon and open up the valve so  this procedure is called a balloon mitral valvotomy. So whenever there is a narrowing of the valve if  the valve is suitable we can do a balloon mitral valvotomy. So the balloon mitral valvotomy is usually  performed when the valve area is less than 1.5 cm square. So if the valve is narrowed below 1.5 cm  square we  perform a  balloon mitral valvotomy. At  the  same  time if  there is any  features  of  heart  failure  or  there  is  evidence  of  severe  increase  in  the  blood  pressure  in  the  lungs  also  called  as  pulmonary hypertension  then we ask  the patient  to undergo a balloon mitral valvotomy at a early  stage.  

If the valve is leaking that is called mitral  regurgitation. So in a patient with mitral  regurgitation as  we have already understood that there will not be any symptom in the early phases of disease. So  we  need  to  do  a  periodic echocardiogram  to  understand  whether  there  is  an enlargement  of  the  heart, whether there is any reduction of the pumping ability of the heart then we have to send these  patients for a mitral valve replacement procedure.  

When is a mitral valve replacement done in mitral regurgitation? 

  • severe mitral valve leaking associated with the enlargement of the heart increase in the blood pressure in the lungs 
  • there is a failure of the right heart  

For a leaky valve we cannot do balloon for a leaky valve we have to only perform a replacement of  the mitral valve.  

 

Types of artificial mitral valves: 

When a mitral valve is replaced this valve can be of two types 

  • Mechanical or a metallic valve 
  • Tissue valve or bio-prosthetic valve  

 

Mechanical or a metallic valve 

So normal valve tissue is a fibrous and it is made of muscular tissue. It’s not truly muscle but similar  to a muscular  tissue. So when we have  this mitral valve, you remove  this valve and replace with a  metallic alloy valve. So this valve is called a mechanical valve or a metallic valve.  

A mechanical valve needs the use of blood thinners or anticoagulants. 

Mechanical valve lasts for decades generally two to three decades or even four decades. 

When a mechanical valve is damaged  the person has  to undergo a  repeat open heart surgery and  replace the valve which is a high risk procedure. 

A mechanical valve even though it is durable it has got a risk of bleeding because of blood thinner  use life-long. 

 

Tissue valve or bio-prosthetic valve

At  times  because  this mechanical valve  has got a lot  of  complications, if the  person is more  than  60  years of age we replace this valve with a tissue valve. Instead of a mechanical valve we have a tissue means these tissue valves are similar to that of a valve which is given by the god or present naturally.  So this mechanical valve is made up of alloy whereas the tissue valve is made up of bovine that means  from the buffalo or from the heart of a pig these valves are constructed. So this tissue valves are akin  to that of normal tissue and they do not have so many complications. 

A tissue valve does not need blood thinners. 

A tissue valve might last anywhere between ten to fifteen years of duration.  

If a tissue valve is damaged then we can replace the tissue valve with a Trans-catheter that means  without surgery we replace the valve going through the groin.  

A tissue  valve  even  though  it  works  for  a  shorter  duration is  preferred especially  in  the  elderly  people (more than 60 years) because these patients do not require lifelong anticoagulation or blood  thinner usage.  

 

Mitra-clip therapy or Trans catheter edge to edge repair 

Patients with mitral regurgitation if the patient has got a severe mitral valve leaking associated with  dysfunction of the heart or the patient is very elderly let’s say more than 75 years of age the surgery  is  considered  high  risk.  So  heart  pumping  dysfunction,  elderly  age  group  or  if  the  patient  had  a  previous  mitral  valve  replacement  either  by  tissue  valve    then  these  are  the  patients  who  are 

considered to be high risk for undergoing a repeat mitral valve procedure or sometimes the patient  can undergo a surgery to the heart like a bypass surgery.  

In those conditions doing a repeat repeat surgery for the mitral valve after a bypass surgery is also  considered high risk.  

Similarly  people  who  have  got  kidney  problem,  people  who  have  got  advanced  age,  people  who  have got a  previous  brain  stroke  those are all  the  patients whom  replacement  of  the mitral  valve  with an artificial  valve is considered high risk.  

For  those  patients  who  have  to  undergo  a  mitral  valve  therapy  or  treatment  and  not  considered  suitable because of their age, kidney failure or brain stroke or poor heart pumping ability, previous  bypass surgery, previous mitral valve surgery in those cases we have to consider other ways where  this mitral valve can be repaired or replaced.  

Due  to new  technological advances we can repair  the mitral valve because if  the valve leaflets are  leaky because there is a gap between those two valve leaflets  for example you consider these two  are mitral leaflets and there is a gap you can bring the leaflets together by putting a clip so the valve  leaflets are getting closer and they can be fastened with a clip.  

So this clip can reduce the leaking or sometimes completely abolish the mitral valve leaking. So this  procedure is called mitra-clip or a transcatheter end to end repair.  

At the same time patients who have got a mitral valve stenosis that means there is no inadequate or  leaking valve but instead the valve is narrowed if it happens after a damage to the tissue valve then  we can replace the valve using a catheter procedure that is what we call as the Transcatheter Mitral  Valve Replacement.  

These  two  advances  like  a  mitra-clip  or  similar  type  of  surgery  and  transcatheter  mitral  valve  replacement are a  boon  for  the elderly  patients with mitral valve  disease who are  considered  not  suitable candidates for getting the mitral valve replacement surgery.  

This is an important advance in those patients with end stage heart failure and a leaking of the mitral  valve.











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