Mitral valve replacement is a cardiac surgical procedure in which the patient's mitral valve is replaced by mechanical or bioprosthetic valves. Mitral valve replacement is performed when the valve becomes too tight (mitral valve stenosis) to allow blood to flow into the left ventricle, or too loose (mitral valve regurgitation) in which blood can leak back into the left atrium and thus return to the lungs.. Mitral valve disease can occur from infection, calcification, collagen-derived disease, or other causes. Because mitral valve replacement is an open heart surgery procedure, it requires patient placement in cardiopulmonary bypass.
Video Mitral valve replacement
Options
Many mitral valves can be repaired instead of replaced, especially for minimally damaged valves. Advantages to repair valves instead of replacement include lower surgical deaths (1-2% for repair versus 6-8% for replacement), lower stroke risk, lower rates of endocardial infections, and long-term survival improvement. Patients receiving valve repair remain on the same survival curve as the normal population. After mitral valve repair, blood thinners are not necessary; However, lifetime care on blood thinners is required after mechanical mitral valve replacement. Mitral valve surgery can now also be done robotically even though the procedure may take longer.
Maps Mitral valve replacement
Non-surgical options
Most patients can have uncomplicated surgery; However, there are some whose heart function is too weak to withstand surgery. The non-surgical approach to treating non-surgical heart valve disease is divided into three categories: Clinical Practice Treatment (this is used in daily clinical practice), Investigative treatment (current clinical study being undertaken), Early Developmental treatment (initial stage of inquiry).
Valve type
There are two main types of artificial mitral valves: mechanical valves and bioprosthetic (biological) valves. Mechanical valves are made of metal and pyrolytic carbon, and can last a lifetime. Patients with mechanical valves should take blood-thinning medications to prevent clotting. Bioprosthetic valve is made of animal tissue. The use of this biological valve allows the patient to avoid blood thinners. However, bioprosthetic valves can only last 10 to 15 years. The choice of valve type used depends on the patient's age, medical condition, preference with medication, and lifestyle.
New Developments (2014 -2017): Mitral transcatheter or TMVR mitral valve replacement involves replacing the mitral valve of the human heart without the aid of open heart surgery. TMVR treats mitral valve stenosis and/or mitral valve regurgitation leading to mitral insufficiency. TMVR, originally developed by the company Tendyne (a subsidiary of Jean Boulle Medtech Ltd.) for high-risk open heart patients is expected to replace the traditional mitral valve replacement surgery in the long term. Tendyne mitral valve is placed inside the heart that ticks through the transkateter at the bottom of the heart through a tube inserted into a small incision in the patient's chest. The doctor uses a tube to spread the valve and position it so that it is located above the mitral valve of the heart. It was then anchored safely in place by an adjustable tether. The valve is fully retrievable, completely repositioned and stitched on the Nitinol framework. Nitinol is a superelastic nickel and a titanium "memory alloy" whose flexibility facilitates implantation, but regains its original shape when it returns to its normal body temperature.
TMVR transition from concept to reality occurs during the period 2014 -2017.
Detailed procedure
Patients undergoing mitral valve surgery receive general anesthesia. The incision may be made somewhat horizontally below the left breast, or vertically through the sternum. After the heart is exposed, the canulae are placed to change the blood route to the heart-lung machine for cardiopulmonary bypass. The incision is made in the left atrium to expose the mitral valve. The valve is then replaced by a biological or mechanical valve. The left artium was then closed, and the patient was weaned from a cardiopulmonary bypass. After surgery patients are usually taken to an intensive care unit (ICU).
Risk
With mitral valve replacement surgery, there are risks such as bleeding, infection or reaction to anesthesia. The risk depends on the patient's age, general condition, specific medical condition, and heart function. Neuropsychological and psychopathological changes after mitral valve replacement surgery have been recognized since the beginning of modern heart surgery.
Variables correlated with nonpsychotic mental disorders after cardiac surgery should be divided into pre-, intra- and post-operative. Incidence, phenomenology, and duration of symptoms deviate from patient to patient, and difficult to define. We wonder whether any patient in either group in this analysis experienced a mechanical heart valve replacement. If so, one should consider Skumin's syndrome, described by Victor Skumin in 1978 as a "cardioprosthetic psychopathological syndrome" associated with mechanical heart valve implants and manifested by irrational fears, anxiety, depression and sleep disorders.
Postoperative complications/risks
A common postoperative complication with mitral valve surgery in a study involving 99 patients undergoing surgery for mitral regurgitation from January 1990 to June 1996 was atrial fibrillation. This occurs in 32% of patients. A common lung complication is congestion requiring prolonged use of oxygen. Other patients require prolonged ventilation for more than 24 hours for conditions such as pulmonary edema, ARDS, and pulmonary thromboembolism. Nine patients had kidney failure with six of them dying within 30 days after surgery. Five patients had a permanent stroke, and nine patients were admitted back to the hospital within 30 days after they were discharged.
Effectiveness
In a clinical study of 99 patients undergoing mitral valve surgery for regurgitation from January 1990 to June 1996, long-term and short-term outcomes were evaluated. This evaluation includes; death rates, clinical complications, readmissions, valve damage, re-surgery, and health perception. Overall mortality was 4%, including 3 operative deaths and 4 final deaths. The overall 5-year survival rate is 92%.
Condition after mitral valve replacement
After surgery, the patient is taken to the post-operative intensive care unit for monitoring. Respirators may be required for the first few hours or a few days after surgery. After a day, the patient should be able to sit in bed. After two days, the patient can be excluded from the intensive care unit. Patients usually run out after about seven to ten days. If mitral valve replacement is successful, patients can expect to return to their regular condition or even better.
Patients who have biological valves are given blood thinners (anticoagulants) with warfarin for 6 weeks to 3 months postoperatively, while patients with mechanical valves are given blood thinners for the rest of their lives. These blood thinners are taken to prevent blood clots that can move to other body parts and cause serious medical problems, such as heart attacks. Blood diluents will not dissolve blood clots but they prevent other clots from forming or preventing the lumps becoming larger.
After the patient's wounds are healed they should have little, if any, restrictions from daily activities. Patients are advised to walk or do other physical activities gradually to regain their strength. Patients who have physically demanding jobs should wait a little longer than those who do not. Patients are also prohibited from driving a car for six weeks after surgery.
Once a person has a mitral valve procedure, they are required to have prophylactic antibiotics as a precaution against infection whenever they perform dental treatment. Some scar tissue occurs after surgery. For the median sternotomy (access through the sternum, or breastbone), the patient will have a vertical scar on the anterior chest above the breastbone. If the heart is accessed from below the left breast there will be a smaller scar at this location.
See also
- Mitral regurgitation
- Mitral stenosis
- Artificial heart valves
- Heart surgery
- The heart-lung machine
References
External links
- Mitral Valve Replacement vs. Repair
- BCM: Department of Surgery Michael E DeBakey. Mitral Valve Replacement/Replacement. n.d. Apr. 29th. 2007
- "The FDA approves a second clinical trial for robotic heart surgery." News Health Sciences. 9 November 2000. Division of Health Sciences ECU. 2 May 2007
- "Heart Disease: Warfarin and Other Blood Diluents." WebMD. Cleveland Clinic. May 10, 2007
- Heart and Vascular Institute. Heart Valve Disease - Percutaneous Intervention: Non-surgical approach. 2007. May 7, 2007
- "Mitral Valve Replacement." University of Maryland Medical Center: 1-2. Apr. 26th. 2007
- Motulsky, Harvey. Intuitive Biostatistics . Oxford University Press Inc., 1995. May 2, 2007
Source of the article : Wikipedia
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