HomeHealth A-ZCardiologyAll About Mitral Valve Repair

All About Mitral Valve Repair

Overview

The Mitral valve, also called the bicuspid valve, is one of the heart’s four valves. Located on the left side of your heart, it helps prevent blood from flowing backward when it moves through the heart.

In a mitral valve disease, the mitral valve between the upper left heart chamber called the left atrium and lower left heart chamber, the left ventricle, does not work properly. It may not close properly, resulting in blood leaking backward to the left atrium (regurgitation), or the valve may become narrowed (stenosis).

What are the symptoms of mitral valve disease?

Mitral valve disease can cause symptoms like fatigue, loss of energy, shortness of breath and heart murmur (an abnormal heart sound) heard through a stethoscope, including irregular heartbeats.

What is the Treatment for Mitral Valve Disease?

Treatment for mitral valve disease depends entirely upon its severity or if the condition is gradually getting worse, or if the individual is experiencing symptoms of this disease.

A heart specialist can help guide you on appropriate care. Although some medications may bring some relief and ease the symptoms, doctors may recommend surgery to either repair or replace the mitral valve for some people with mitral valve disease.

What is Mitral Valve Repair Surgery?

Mitral valve repair is a procedure to repair the mitral valve, which is not working properly due to valvular heart disease. A person with mitral valve disease can have one of two malfunctions including:

  1. Mitral Valve leak (Regurgitation): This happens when the valve does not close completely, resulting in the blood flowing backwards.
  2. Mitral Valve Stenosis happens when the valve becomes narrow or does not open properly, obstructing blood flow out of the heart’s chambers. When this occurs, your heart is forced to pump blood with increased force to move the blood through the stenotic (stiff) valve.

How is a mitral valve disease diagnosed?

The first step of diagnosis involves listening with a stethoscope. Your physician can hear your heart’s murmur using a stethoscope, which may represent turbulent blood flow across the abnormal valve. The diagnosis can be confirmed further by conducting an echocardiogram that allows the physician to see the heart valves and determine the cause and severity of the mitral valve defect.

The doctor may use a  transthoracic echocardiogram in many patients and may also place a probe on your chest to visualize the valve. Sometimes, a transesophageal echocardiogram, which includes a probe passed through the mouth into the oesophagus, becomes necessary to visualize the valve more closely; this is an outpatient procedure.

How is mitral valve repair surgery performed?

There are different techniques for mitral valve repair. While most of them are performed during an open-heart surgery, in certain cases, mitral valve repair is done using a small cut/incision, in a minimally invasive procedure, without having to cut open the chest.

  • Annuloplasty: Thisis a mitral valve repair operation where the abnormal section of your heart’s valve is removed and the edges are sewed back together, while a cloth-covered ring is placed around the valve
  • Commissurotomy is a mitral valve repair procedure where the mitral valve flaps are separated surgically to relieve stenosis.

Sometimes, the damaged mitral valves cannot be repaired and have to be replaced.

What are the indications for surgical repair of mitral valve regurgitation (leaking mitral valve)?

Surgery is considered when the leak is severe. In many healthcare facilities, the leak (regurgitation) is graded on a scale from 0 to 4, with 0 indicating no leak and 4 indicating a severe leak.

Surgery is recommended in virtually all patients suffering from a leak graded as 4 or severe and in few patients with a leak graded as a 3 or moderately severe. Surgery is also recommended when a patient suffering from mitral regurgitation develops any symptoms, an increase in heart size, or experience a decrease in heart function.

Surgery is also considered when the patient develops atrial fibrillation (irregular heartbeat). In addition, surgery may also be suggested for even asymptomatic patients who have a severe leak. In asymptomatic patients with severe mitral leak (regurgitation), surgery may improve long-term survival, while waiting for any changes or development of symptoms in heart functions may leave patients with permanent heart damage.

What are the benefits of mitral valve repair surgery? Why repair better than mitral valve replacement?

There are several benefits of mitral valve repair surgery over valve replacement. These include:

  1. Early recovery and improved survival rates (Longer life!)
  2. Better heart function post-surgery
  3. Improved lifestyle
  4. Lower risk of stroke and infection (endocarditis)
  5. Eliminates need for blood thinners (anticoagulation) after surgery

For these reasons, surgeons at Apollo Hospitals are committed to mitral valve repair surgery offering the best possible clinical outcomes.

Mitral Valve Repair at Apollo Hospitals

At Apollo Hospitals, we have the world’s greatest experience with mitral valve repair, the best option for most patients with mitral valve regurgitation (a leaking mitral valve).

Our renowned specilists have world-class expertise in mitral valve repair. As a result, all mitral valve regurgitation (leaking mitral valves) cases at Apollo Hospitals are mostly repaired rather than replaced.. In addition, for those with isolated mitral valve conditions, the majority of surgeries are performed minimal invasively or robotically, thus ensuring quick recovery.

Minimally Invasive Mitral Valve Repair at Apollo Hospitals

Heart specialists at Apollo Hospitals are considered pioneers in developing minimally invasive techniques for mitral valve repairs. Today, most of the isolated mitral valve repair surgeries can be performed through two-three inch cut/incision on the right side of the chest. In most cases, we employ a surgical robot and limit cut size to just one inch.

At Apollo, several minimally invasive approaches are available to patients. These include a small incision in the mid-line, a small incision on the right chest and robotically assisted surgeries. Our expertise with many approaches enables us to discover the best possible procedure for each patient, optimizing best possible results.

Minimally invasive approaches can also be used for patients who need tricuspid valve or aortic valve surgery, alone or in combination with mitral valve surgery. Furthermore, Apollo Hospitals is a leader in percutaneous (through the skin) minimally invasive MitraClip therapy.

Minimally Invasive MitraClip Valve Repair At Apollo Hospitals

The minimally invasive method used in MitraClip therapy allows repair of a leaking mitral valve without an open-heart surgery. MitraClip is the only percutaneous technology effective in both functional and degenerative mitral regurgitation. With the MitraClip, Apollo Hospitals can treat patients with severe mitral regurgitation who are at prohibitive surgical risk and offer them a second lease of life.

MitraClip Valve Repair Procedure

The MitraClip device is delivered to the heart through a small cut/incision in the blood vessel in the leg. The procedure is performed percutaneously in a cath lab, and the MitraClip device can be repositioned and removed.

The heart continues to beat during this procedure and does not need a heart-lung bypass machine, which is very common for open-heart surgery. During the surgery, a catheter –  a flexible thin plastic tube –  is inserted through the patient’s skin in the groin region and guided through the femoral vein to the affected heart area.

After this, a catheter that holds the MitraClip device goes inside through the first catheter to guide the MitraClip into the place and the clip is attached to the mitral valve’s leaflets. Once the MitralClip is inserted properly and fastened securely, it is deployed, and the catheters are removed.

Advantages of minimally invasive MitraClip Therapy

MitraClip therapy improves valve function  and reduces regurgitation (leaks or backflow of blood). The heart will return to pumping blood efficiently to the body, thus relieving the patient’s symptoms and improving his/her quality of life. Other advantages include less pain, faster recovery, reduced need for blood transfusion and better cosmetic outcomes.

Specialists at Apollo Hospitals evaluate each patient for minimally invasive MitraClip therapy, and work with patients to choose the best and the safest approach in their individual cases.

Who Can Benefit From MitraClip therapy?

Advantages of MitraClip therapy include:

  1. A good alternative for patients who are not eligible for an open heart surgery
  2. A frail or elderly patient or a patient with a very weak heart
  3. Patient with a history of any other non-cardiac diseases involving the brain, kidneys or lungs
  4. Patients who earleir underwent open-heart surgery due to higher risk for a re-operation

Frequently Asked Questions

What is MitraClip?

The MitraClip procedure is used for the treatment of patients with mitral valve regurgitation (leak). Mitral regurgitation happens when your heart’s mitral valve does not close tightly, resulting in the blood to flow backward (or leak backwards ) in your heart. When the blood flows backward through your mitral valve, it increases the workload of the heart, often causing shortness of breath.

How is the MitraClip procedure different from traditional open-heart surgery?

In conventional open-heart surgery, the heart surgeon cuts or makes an incision in the centre of the chest and opens your heart to repair or replace the mitral valve. You will be placed on a cardiopulmonary bypass machine (also called the heart-lung bypass machine) to divert the flow of blood from your heart while it is stopped.

In the MitraClip procedure, the surgeon does not need to cut open the chest or temporarily stop your heart and put you on a cardiopulmonary bypass machine. Instead, your surgeon will access your heart through a vein in your leg to repair the mitral valve.

Who is eligible for the MitraClip procedure?

  1. MitraClip procedure is a feasible option for patients with severe symptoms of mitral valve regurgitation who are at a high surgical risk due to their comorbidities.
  2. The procedure is an option for mitral regurgitation patients who are too sick for surgery
  3. Frail or elderly patient or a patient with a very weak heart is also a candidate for MitraClip procedure
  4. MitraClip procedure is an option for patient with a history of any other non-cardiac diseases involving the brain, kidneys or lungs
  5. The procedure is also for patients who earleir underwent open-heart surgery, due to higher risk for a re-operation

What is MitraClip device made of? How does it reduce mitral valve regurgitation (leak)?

The MitraClip device is a small metal clip that is covered with a polyester fabric. The device is inserted in the mitral valve. The MitraClip treats mitral valve leaks by clipping together a small area of mitral valve. The valve can continue to open and close on either side of this clip. This enables the blood to flow on both sides of the clip while reducing the blood flow in the wrong direction.

How is the MitraClip procedure performed?

At Apollo Hospitals, the procedure is performed in our hybrid catheterization lab. A team of specialists work closely together to perform this procedure. The team makes use of a fluoroscope (a special X-ray machine) and transesophageal echocardiogram (ultrasound machine) to see inside your body to guide the  catheter during this procedure.

The following describes the procedure:

  1. A small opening is made in a large vein (femoral vein) in the groin region at the top of your leg.
  2. A thin catheter (long, flexible tube) is threaded up to the heart using ultrasound and X-Ray imaging guidance.
  3. The MitraClip is inserted using a tool on the tip of the catheter to make a tiny hole through the septum (a thin muscle layer) to fix the leaking part of your mitral valve.
  4. The MitraClip grasps, pulls the front and back leaflets of the mitral valve, and clips them together,r enabling the leaky valve to close better.  This reduces blood leaking backwards.
  5. As soon as the MitraClip is placed, the specialist will remove the catheter and the sheath.

For how long will I stay in hospital after the MitraClip procedure?

After the procedure, you will be shifted to the post-operative recovery area first. The time of your stay there depends on your recovery from anaesthesia. While most patients are likely to stay in the hospital for 72 hours, the length of your stay in this room depends on many factors. You will be shifted to a room once you are considered stable.  

What are the advantages of the MitraClip procedure?

Following are the benefits of the MitraClip procedure:

  1. Shortened recovery time
  2. Faster return to everyday activities compared to open heart surgery
  3. Shorter hospital stay
  4. Improved quality of life (about 4 weeks following the procedure), including the ability to return to the normal daily routine
  5. Relief from symptoms
  6. Reduced pain and anxiety
  7. Improved heart function

Do patients who have undergone mitral valve repair surgery need re-operation?

After mitral valve repair, close to 95 per cent of patients may not need reoperation till 10 years, and this figure is about 90 per cent at 20 years. Therefore, re-operation is very uncommon after a successful mitral valve repair procedure.

An ECG (echocardiogram) is recommended every year to assess your valve function. Furthermore, patients who have undergone valve surgery should take steps to prevent infection and reduce the risk of an infection of the valve (endocarditis).

Why is it important to have your surgery at a facility with greater experience in mitral valve repair surgery?

Mitral valve repair is the best option over valve replacement for almost all the patients with regurgitant (leaking) mitral valve and for many other patients with a stenotic (narrowed) mitral valve. Compared to valve replacement, mitral valve repair offers better preservation of heart function, lower risk of complications, improved long-term survival and usually eliminates the need for long-term use of blood thinners. For these reasons, surgeons at Apollo Hospitals are committed to mitral valve repair whenever possible.

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The content is reviewed and verified by our experienced and highly specialized team of heart specialists who diagnose and treat more than 200 simple-to-complex heart conditions. These specialists dedicate a portion of their clinical time to deliver trustworthy and medically accurate content

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