Fixing and replacing the mitral valve

Fixing and replacing the mitral valve, A little flap in the heart known as the mitral valve regulates blood flow direction and prevents it from flowing in the wrong direction. The left atrium and left ventricle, which are the left-hand chambers of your heart, are connected by the valve.

When the mitral valve in your heart becomes stiff or leaks, there are two options for treatment: repair or replacement.

The goals of the operations are to increase blood flow to the heart and decrease the likelihood of additional cardiac issues. Possible methods of execution include open-heart surgery (via the breastbone), minimally invasive surgery (8 cm between the ribs), entirely endoscopic (2–3 cm opening under the right breast), and transcatheter techniques, which do not involve surgery but are nonetheless considered minimally invasive.

Several criteria, including the severity of your disease, your age, and any other medical conditions you may have, will determine the type of mitral valve treatment that you undergo. Every patient is different, and not every operation will work for them.

Mitral valve disease

There are various varieties of mitral valve disease:

When the mitral valve flaps are unable to shut completely, blood can leak backwards, a condition known as mitral valve regurgitation. “Primary” refers to when the valve leaflet cords get longer or break, like in mitral valve prolapse. “Secondary” refers to when the left ventricle, left atrium, or an infection are involved.
The flaps of the mitral valve get thicker and may even fuse together. This makes the mitral valve stenosis, which narrows the valve and lowers blood flow to and from the heart. Rheumatic heart disease most commonly causes this, although aging and radiation also play a role.
You may be advised to undergo an operation to fix or replace the damaged valve if your condition worsens to a point where symptoms manifest, cardiac function declines, or the size of your heart increases.

Mitral valvular disease treatment

There are a number of important distinctions in the procedures and circumstances that call for mitral valve replacement vs. repair for treating mitral valve dysfunction. There are many surgical and non-surgical options at Royal Brompton and Harefield hospitals. These include minimally invasive procedures, completely endoscopic procedures (using a 4K 3D camera system with robotic arms), and options other than surgery.

The mitral valve repair is what?

Patients often suggest mitral valve replacement as an initial step in the treatment of regurgitation, even in the absence of symptoms.

Transcatheter, minimally invasive, entirely endoscopic keyhole, or open-heart surgery are all viable options for its execution.

Your mitral valve may need the following repairs:

fix it using sutures or stitches.

Form it into a ring, cut away any extra tissue, clip the valve flaps together, and then attach prosthetic cables to the heart muscle wall.
The mitral valve replacement is what?
If the severity of your condition makes repair impossible, we will typically suggest a replacement mitral valve.

The damaged valve is surgically removed and replaced with a new one, which can be mechanical (made of synthetic materials) or biological (formed from tissues taken from the patient).

While a mechanical valve will last longer, it does raise the danger of blood clots, which means you’ll have to take anticoagulants (blood thinners) forever. They are more likely to get endocarditis (an infection) and can be noisy (ticking sound) as well.

Contrarily, you won’t need to take anticoagulants with replacement valves derived from biological tissue, and they should endure for 10 to 15 years. Nevertheless, it might be necessary to replace it once more in the future.

Fixing and replacing the mitral valve

The inaugural Edwards Lifesciences Mitris Resilia valve, which is accessible to younger patients and anticipated to have a durability of over 20 years, was successfully installed by our doctors.

At both Royal Brompton and Harefield hospitals, patients can choose between open-heart, minimally invasive, or entirely endoscopic keyhole procedures to replace a mitral valve. Based on your age, health status, and other considerations, your doctor will advise you on the best course of action.

Restoring and replacing the mitral valve with minimally invasive surgery
The experts at Royal Brompton and Harefield hospitals have helped create a number of cutting edge methods for replacing and fixing mitral valves through minimally invasive and endoscopic methods.

Take a look at the endoscopic robotic-aided surgeries and minimally invasive procedures offered by our hospitals below.

Mitral valve regurgitation treatment with the TEER technique
One less intrusive option for treating mitral valve regurgitation than open-heart surgery is transcatheter mitral valve repair. We use either MitraClip or Pascal, two currently available devices.

The technique involves making a little incision in your groin and inserting a catheter, which is like a tube, with the TEER device attached to its end. After a cardiologist guides the catheter through the femoral vein and into the heart, they use echo and x-ray imaging to secure the device to the mitral valve.

After the operation, which can take anywhere from one to two hours, patients often notice an immediate improvement in their quality of life. In 90% to 95% of cases, patients report an improvement in their symptoms.

When the risks associated with open-heart surgery are too great or not acceptable, this procedure can be very helpful for the patient. An older patient or one with “secondary” mitral regurgitation (caused, for instance, by weak heart muscle) are two such examples.

When it comes to TEER expertise, no hospital in the UK can match Royal Brompton and Harefield.

Treatment of mitral valve stenosis with balloon valvuloplasty
A catheter-delivered balloon valvuloplasty is an example of a minimally invasive procedure. Medical imaging guides the catheter to the heart through a tiny groin incision.

The balloon is inflated to enlarge the mitral valve when it reaches the narrowed area and then deflated and removed. This method can treat mitral valve stenosis.

Endoscopic mitral valve replacement and repair using a keyhole technique
Our consulting cardiac surgeons have developed a novel endoscopic (keyhole) technique for repairing or replacing a damaged mitral valve. As an alternative to intrusive open-heart surgery, this novel treatment provides a viable option.

An endoscope, a thin, flexible tube with a camera attached to its end, is inserted into a tiny 2.5 cm incision made between your ribs in order to carry out the surgery.

The surgery, which takes about four hours to finish, uses robotic arms guided by a high-definition 3D camera to access your heart.

Compared to open-heart surgery, the recovery time and size of the surgical scar from an endoscopic mitral valve repair or replacement procedure are significantly shorter. Studies have also proven this method to be equally safe.

In contrast to the three months required for conventional open-heart surgery, patients undergoing percutaneous coronary intervention (PCI) procedures are typically discharged four days following surgery and can resume normal activities (including driving) within three weeks.

Our surgeons have performed nearly a thousand cases, making them experts in endoscopic cardiac surgeries.

NeoChord repair for mitral valve dysfunction
Some types of mitral valve regurgitation and prolapse can make it hard for the valves to open and close properly. This is because the chordae tendineae can get stretched or damaged, which is what connects the valve leaflets to the heart muscle wall.

The NeoChord method is a cutting-edge keyhole heart surgery that fixes the mitral valve leaflets’ chords that join to the heart muscle wall.

The NeoChord device will be advanced to the heart through a tiny incision made in the intercostal space by a surgeon using medical imaging as a guide. To restore the normal opening and closing of the mitral valve, the surgeon will implant prosthetic chords that are precisely adjusted to the correct length throughout the process.

The NeoChord operation continuously monitors your heart. Patients who are elderly or who have conditions that increase the risk of standard open-heart surgery may benefit from this. Additionally, scarring is low because the operation is a keyhole heart treatment.

Mitral valve replacement using the Tendyne transcatheter system (TMVR)
The Tendyne Transcatheter Mitral Valve Replacement (TMVR) procedure can be used to treat severe cases of mitral valve regurgitation in older or more fragile patients or those with health problems that make open heart surgery more dangerous.

This minimally invasive surgery, similar to our other keyhole heart operations, only requires a small incision between the ribs. The heart also doesn’t have to be stopped for it to work.

Implanting your new artificial mitral valve into your beating heart will tether it to your heart.

Results were favorable for 100 patients treated with Tendyne TMVR for severe mitral valve regurgitation in a research trial. Two years following the treatment, 93% of patients still hadn’t felt a thing.

The Tendyne TMVR technique is exclusively available at Royal Brompton Hospital in the UK.

What to do in the days leading up to a mitral valve procedure
It is crucial that you follow your doctor’s instructions on pre-procedure preparations.

Here are some common tips for getting ready:

Following your doctor’s orders, discontinue taking certain medications at least one hour before your appointment. Be sure to bring a complete list of your medications, any allergies you may have, as well as any other personal care items you may need, like a toothbrush. Wear loose-fitting clothing.
We may ask you to remove your dentures, contact lenses, nail polish, and jewelry before surgery.

Potential dangers and issues with fixing or replacing the mitral valve
Mitral valve repair and replacement, like any minimally invasive or surgical operation, carries with it the possibility of problems and dangers.

The following are examples of possible dangers:

virus outbreak
stroke, blood clots, hemorrhage, new valve dysfunction, abnormal heartbeat (arrhythmia),
Having performed over a thousand procedures, we can say with confidence that the dangers of mitral valve repair and replacement are minimal and infrequent.

Findings and healing procedures for mitral valve replacement or repair
In order to improve and sustain your outcomes after mitral valve repair or replacement, the recovery phase is critical.

You should expect to spend at least seven days in the hospital following conventional open-heart surgery. Before going home, get enough sleep and follow your doctor’s orders.

Until at least six to eight weeks have passed, you should avoid driving, lifting heavy things, and engaging in sexual activity. Also, consult your physician before engaging in any physically demanding activity.

A less invasive surgery, such as an endoscopic one, may allow you to recuperate more quickly.

This mitral valve operation yielded the following results:

alleviating symptoms like shortness of breath and chest discomfort
lessening the likelihood of developing more cardiac issues, including heart failure
improving the efficiency of your heart
permitting an average lifespan
Incorporating healthy lifestyle adjustments into your daily routine is essential if you want these improvements to endure. For this reason, it’s important to exercise (to the best of your ability), cut back on alcohol, quit smoking, eat a balanced diet, and get plenty of sleep every night.

All patients in our unique, dedicated, multidisciplinary team come to a collaborative decision and agree on the appropriate treatment.