Mitral Valve Replacement: Open
What is an open mitral valve replacement?
An open mitral valve replacement is a surgery to replace a poorly working mitral valve
with an artificial valve. The mitral valve is 1 of the heart’s 4 valves. It helps
blood flow through the heart and out to the body. The mitral valve lies between the
left atrium and the left ventricle. It allows blood to flow from the left atrium (top
chamber) to the left ventricle (bottom chamber) in the heart. Your doctor will replace
your poorly working mitral valve with an artificial valve. This will ensure that blood
can flow into the left ventricle and then flow out to the body normally, without putting
extra stress on the heart. The surgery is called “open” because it uses a traditional
larger incision to expose the heart. This incision is larger than the incision used
in minimally invasive mitral valve replacement surgery.
Why might I need an open mitral valve replacement?
The procedure may be necessary if the mitral valve is working poorly. Surgical repair
of the mitral valve is often possible, but sometimes the valve needs to be replaced.
Mitral valve stenosis and mitral valve regurgitation (also known as mitral insufficiency)
are two different types of problems that might need valve replacement.
In mitral valve stenosis, the valve is unable to open fully, and less blood is able
to move from the left atria into the left ventricle.
In mitral valve regurgitation, the valve is leaky. Some blood leaks back into the
left atrium instead of moving forward into the left ventricle.
These valve problems can lead to such symptoms as fatigue, shortness of breath, fluid
buildup in the legs (edema(, fluid build up in the lungs (pulmonary edema), and heart
paplpitations.. If these symptoms become severe, and/or the valve is severely damaged,
surgery may be necessary.
Both mitral stenosis and mitral regurgitation can result from general aging of the
valve. Other causes of mitral valve disease include:
Ischemic heart disease (coronary artery disease)
Infection of the heart valves
Congenital heart defect (something you are born with)
What are the risks of an open mitral valve replacement?
Most people who have an open mitral valve replacement have a successful outcome, but
there are certain risks. Your particular risks will vary based on your overall health,
your age, and other factors. Be sure to talk with your doctor about any concerns that
you have. Possible risks include:
Bleeding either during the surgery and after, and at a later time from the long term
anticoagulation if required
Irregular heart rhythms, possibly requiring a permanent pacemaker
Blood clots leading to stroke or heart attack
Complications from anesthesia
Continued leaking of the valve
Damage to nearby organs
Memory loss or problems with concentration
Certain factors increase the risk of complications, like:
How do I get ready for an open mitral valve replacement?
As you plan for the surgery, you and your doctor will decide what kind of valve will
work best for you. Your surgeon will replace your valve with a biological valve or
a mechanical valve.
Biological valves are made mainly from pig, cow, or human heart tissue. Biological
valves don’t last as long as mechanical valves
Mechanical valves are man-made. If you receive a mechanical valve, you will need to
take blood-thinning medicine for the rest of your life. This is to help prevent clots
that can form on the valve and may cause stroke or the working part of the valve to
become frozen and non-working.
Talk with your doctor about how to prepare for your upcoming surgery. Remember the
Avoid eating or drinking anything after midnight before your surgery.
Try to stop smoking before your operation. Ask your doctor for ways to help.
You may need to stop taking certain medicines before your surgery. Follow your doctor’s
instructions if you usually take blood-thinning medicines like warfarin or aspirin.
Be clear on which medications to stop prior to surgery and when, as well as which
medications to continue taking.
Tell your doctor about all medicines (prescription and over-the-counter), vitamins,
herbs, supplements and recreational drugs that you are taking.
Tell your doctor if you are sensitive to or are allergic to any medicines, iodine,
latex, tape, or anesthetic agents (local and general).
Tell your doctor if you have a pacemaker or any other implanted cardiac device or
any other implanted device.
If you are pregnant or think you could be, tell your doctor.
You may need to arrive at the hospital the afternoon before your operation. This is
a good time to ask any questions you have about the procedure. You may need some routine
tests before the procedure to assess your health before surgery. These may include:
About an hour before the operation, someone will give you medicines to help you relax.
In most cases your surgery will proceed as planned, but sometimes another emergency
might delay your operation.
What happens during an open mitral valve replacement?
Check with your doctor about the details of your procedure. In general, during your
open mitral valve replacement:
A doctor will give you anesthesia before the surgery starts. This will cause you to
sleep deeply and you will not feel pain during the operation. Afterwards you won’t
The operation will take several hours. Family and friends should stay in the waiting
room, so the surgeon can update them.
Your doctor will make an incision down the middle of your chest. To access your heart,
your doctor will separate your breastbone.
The surgery team will attach you to a heart-lung machine. This machine will act as
your heart and lungs during the procedure.
Your surgeon will remove your current mitral heart valve and replace it with a new
The surgery team will remove the heart-lung machine.
The team will wire your breastbone back together.
The team will then sew or staple the incision in your skin back together.
What happens after an open mitral valve replacement?
After your open mitral valve replacement:
You will begin your recovery in the intensive care unit or a recovery room.
When you wake up, you might feel confused at first. You might wake up a couple of
hours after the surgery, or a little later.
Most people who have mitral valve replacement notice immediate symptom relief after
The team will carefully monitor your vital signs, such as your heart rate. They may
hook you up to several machines so the nurses can check these more easily.
You may have a tube in your throat to help you breathe. This may be uncomfortable,
and you won’t be able to talk. Someone will usually remove the tube within 24 hours.
You may have a chest tube to drain excess fluid from your chest.
Bandages will cover your incision. These can usually come off within a couple of days.
You will feel some soreness, but you shouldn’t feel severe pain. If you need it, you
can ask for pain medicine.
In a day or two, you should be able to sit in a chair and walk with help.
You may perform breathing therapy to help remove fluids that collect in your lungs
You will probably be able to drink the day after surgery. You can have regular foods
as soon as you can tolerate them.
You may receive elastic stockings to help blood circulate through your leg veins.
You will probably need to stay in the hospital for around 5 days but this can vary
from patient to patient.
After you leave the hospital:
Make sure you have someone to drive you home from the hospital. You will also need
some help at home for a while.
You will probably have your stitches or staples removed in a follow-up appointment
in 7 to 10 days. Be sure to keep all follow-up appointments.
You may tire easily after the surgery, but you will gradually start to recover your
strength. It may take several weeks to fully recover from your surgery.
After you go home, take your temperature and your weight every day. Tell your doctor
if your temperature is over 100.4°F (38˚C), or if your weight changes.
Ask your doctor when it is safe for you to drive.
Avoid lifting anything heavy for several weeks. Ask your doctor about what is safe
for you to lift.
Follow all the instructions your healthcare provider gives you for medications, exercise,
diet, and wound care.
If you have a mechanical valve, you will need to take blood thinner medicine. This
is medicine that helps prevent clots. Blood thinners require frequent monitoring of
levels and certain foods and medicines can interact with these drugs. Make sure you
know all about the blood thinners you are prescribed before you leave the hospital.
Make sure all your dentists and doctors know about your medical history. You may need
to take antibiotics before certain medical and dental procedures to prevent getting
an infection on your replacement valve.
Your doctor may suggest that you begin a cardiac rehabilitation program, which gradually
reintroduces you to a normal lifestyle. Cardiac rehabilitation begins in the hospital
with simple walking, and progresses to the development of a regular exercise routine
and a nutritious diet. Committing to healthier habits can prevent future heart problems.
Before you agree to the test or the procedure make sure you know:
The name of the test or procedure
The reason you are having the test or procedure
What results to expect and what they mean
The risks and benefits of the test or procedure
What the possible side effects or complications are
When and where you are to have the test or procedure
Who will do the test or procedure and what that person’s qualifications are
What would happen if you did not have the test or procedure
Any alternative tests or procedures to think about
When and how will you get the results
Who to call after the test or procedure if you have questions or problems
How much will you have to pay for the test or procedure