Cardiac Surgical Procedures

Heart Valve Repair or Replacement Surgery

Surgery is required for severe mitral valve regurgitation (MR). Surgery for MR is recommended when the symptoms of heart failure are present and when your ejection fraction drops below 60 percent and your left ventricle is larger than 45 mm at rest.
Generally, surgery for mitral valve prolapse (MVP) is only done when mitral valve regurgitation is present. Valve repair or replacement are the two types of surgeries available to treat these conditions. Valve repair or replacement is an open-heart surgery. You are given general anesthesia and placed on a heart-lung machine during the surgery, which usually lasts about 3 to 5 hours.
The decision between repairing or replacing the valve depends on the type of damage to the mitral valve. For instance, repair is more successful if there is limited damage to certain areas of the mitral valve flaps (leaflets) or to the tough fibers that control movement of the mitral valve leaflets (chordae tendineae). Replacement, however, is usually preferred for people who have a hard, calcified mitral valve ring (annulus) or widespread damage to the valve and surrounding tissue. For heart valve repair, one of the following procedures is done: - Reshaping of the valve by removing excess valve tissue - Adding support to the valve ring by adding tissue or a collarlike structure around the base of the valve - Attaching the valve to nearby heart cordlike tissues (chordal transposition) Heart valve replacement surgery involves the removal of the badly damaged valve. The valve is replaced with a plastic or metal mechanical valve, or a bioprosthetic valve.
Recovery from heart valve surgery usually involves a few days in our cardiac intensive care unit (CICU). Full recovery from heart valve surgery can take several months. Recovery includes healing of the surgical incision, gradual building of physical endurance, and exercise. An exercise program under the direction of a physical therapist or outpatient cardiac rehabilitation specialist is usually recommended.
Once you have an artificial valve, your heart function and your life will largely return to normal. You should feel better than before you had the surgery if your condition was symptomatic; for example, you should no longer experience shortness of breath and fatigue. However, if your heart was already severely affected before your surgery, you may continue to experience complications of heart disease. You should be able to resume most of your normal activities, although you will have to continue to monitor your condition. You need to watch out for blood clots and infections so it is important that you see your doctor regularly.
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