Definition of Mitral valve surgery - minimally invasive:

Mitral valve surgery is surgery to either repair or replace the mitral valve in your heart.

Blood that comes from the lungs enters the left atrium of the heart and crosses into the left ventricle. The mitral valve between these two chambers makes sure that the blood keeps moving forward. when the mitral valve is hardened (calcified), it prevents the blood from moving forward. When the mitral valve is too loose, the blood tends to flow backwards. Both of these conditions cause symptoms and may require mitral valve surgery.

Minimally invasive mitral valve surgery is done through much smaller surgical cuts than the large cuts needed for open surgery.

See also: Mitral valve surgery - open

Description:

Before your surgery you will receive general anesthesia. This will make you unconscious and unable to feel pain.

There are several different ways to perform minimally invasive mitral valve surgery.

• Your 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 your surgeon can reach the heart. A small cut is made in the left side of your heart so the surgeon can repair or replace the mitral valve.
• In endoscopic surgery, your surgeon makes one to four small holes in your chest. Then your surgeon uses special instruments and a camera to do the surgery.
• For robotically-assisted valve surgery, the surgeon makes two to four tiny cuts (about ½ to ¾ inch) in your 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.

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

If your surgeon can repair your mitral valve, you 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 both of the leaflets of the valve. The leaflets are flaps that open and close the valve.

If your mitral valve is too damaged, you will need a new valve. This is called replacement surgery. Your surgeon will remove your mitral valve and sew a new one into place. There are two main types of new valves:

• Mechanical -- made of man-made materials, such as titanium, or ceramic. These valves last the longest, but you will need to take blood-thinning medicine, such as warfarin (Coumadin) or aspirin, for the rest of your life.
• Biological -- made of human or animal tissue. These valves last 10 - 12 years, but you may not need to take blood thinners for life.

The surgery may take 2 -4 hours.

This surgery can also be done through a groin artery, with no cuts on your chest. The doctor sends a catheter (flexible tube) with a balloon attached on the end. The balloon stretches the opening of the valve. This procedure is called percutaneous valvuloplasty.

Why the Procedure Is Performed:

You may need surgery if your mitral valve does not work properly because:

• You have mitral regurgitation -- a mitral valve that does not close all the way and allows blood to leak back into the left atria
• You have mitral stenosis -- a mitral valve that does not open fully and restricts blood flow
• Your valve has developed an infection (infectious endocarditis)
• You have severe mitral valve prolapse that is not controlled with medications

Minimally invasive surgery may be done for these reasons:

• Changes in your mitral valve are causing major heart symptoms, such as chest pain (angina), shortness of breath, fainting spells (syncope), or heart failure.
• Tests show that the changes in your mitral valve are beginning to seriously affect your heart function.
• Your heart valve has been damaged by infection (endocarditis).

A minimally invasive procedure has many benefits. There is less pain, blood loss, and risk of infection. You will also recover faster than you would from open heart surgery.

Percutaneous valvoplasty is a procedure that is only done in people who are too sick to have anesthesia. The results of this procedure are not long lasting.