Mitral Valve Replacement Surgery in Delhi, India

The patient might be allowed to have a Mitral Valve Replacement if they meet the following conditions:

• They suffer from symptomatic chronic severe primary mitral regurgitation, usually caused by degenerative valve disease.
• A Left Ventricular Ejection Fraction (LVEF) of >30% 
• The patient is symptomatic with severe LV systolic dysfunction (LVEF <30%) refractory to medical therapy (Low comorbidity)

One should avoid mitral valve replacement if:

• They have high comorbidity, meaning they suffer from many diseases.
• The Mitral Valve disease is not severe.
• They can have Mitral Valve Repair, which has lower risk and better post-operative outcomes than Mitral Valve Replacement. 

• Get medically tested before the surgery:
• • Echocardiography and other tests are done to get more information about the heart condition before Mitral Valve Replacement. 
  • The patient will require clearance for surgery from different medical departments, such as cardio, neuro, etc.
  • The medical team assisting in surgery will go over what to expect during surgery and address any concerns the patient may have.
• Arrange a ride back home
• • Talk to the family and relatives about the hospital stay. The patient should arrange a ride from the hospital.     
• Talk to the doctor
• • The patient should inform the doctors about the medications and supplements they take. 
  • They should also ask when or if they can take them before surgery. 
  • Let them know about any allergies to a particular medication.    
• Fasting before the procedure
• • The doctor will tell patients not to eat or drink before the surgery.
• The patient cannot work for a while.
• • After the treatment, patients may not return to work for up to two weeks. The type of laser surgery conducted on the patient, however, would dictate the recovery period.

The Mitral Valve provides nutrient and oxygen-rich blood to flow through heart chambers. It is supposed to close and open with the heartbeat by obstructing and opening the blood flow. However, a diseased Mitral Valve cannot do that. The signs and symptoms of Mitral Valve disease are as follows:

• Fatigue
• Dizziness
• Lightheadedness
• Shortness of breath
• Cyanosis
• Chest pain
• Fluid retention in the lower limbs

The diagnosis of Mitral Valve disease is made by performing tests, imaging, and going through the medical history. During the physical exam, the physician will listen for a heart murmur. If there is any abnormality, they will do further tests. Some of them are: 

• Echocardiogram: An echocardiogram allows the clinician to examine the Mitral Valve in detail and assess its function. Echocardiography is used to diagnose rheumatic Mitral Valve disease, congenital Mitral Valve disease, and other heart valve diseases.
• Electrocardiogram (EKG): An ECG can detect enlarged heart chambers, heart disease, and irregular heart rhythms by measuring electrical signals of the heart.
• Chest X-ray: A chest X-ray can reveal information about the heart and lungs. It can show if the heart has enlarged (a symptom of some types of heart valve problems).
• Cardiac MRI: This examination creates comprehensive pictures of the heart using magnetic fields and radio waves. MRI helps to identify the severity of Mitral Valve disease.
• Exercise stress test: These tests frequently entail walking on a treadmill or riding a stationary bike while having the heart rate monitored. Exercise tests can indicate how the heart responds to physical activity and whether symptoms of valve dysfunction arise during exercise. If the patient cannot exercise, they may be given drugs that have the same effect on their heart as exercise.

 After determining the disease, doctors will identify its stage and can come up with an appropriate treatment plan. Following are the four stages of Mitral Valve disease: 

• Stage A: At risk. 
• Stage B: Progressive. Valve disease is mild. 
• Stage C: Asymptomatic severe. The valve disease is severe without cardiac symptoms.
• Stage D: Symptomatic severe. Heart valve disease is severe and symptomatic.

For stage D and sometimes for Stage C, the doctor may suggest mitral valve replacement. 

Eventually, even if no symptoms are present, a damaged mitral valve may need to be repaired or replaced. The doctor may fix the existing mitral valve for it to work. If that is not an option, the patient may need to have a Mitral Valve replaced.

They will replace the faulty Mitral Valve with an artificial metal or a biological valve. A metal valve will last a lifetime, but it will require the use of blood thinners. The biological valve will last between 15 and 20 years, and the patient will not be required to take blood-thinning medication. Some factors influence survival rates:

• Age
• Overall health
• Other health conditions the patient has,
• Heart function

The surgeons open the chest to access the heart and the damaged valve. The technique varies from patient to patient, but it usually takes at least two hours and is often much longer. Any tissue or calcium deposits interfering with the valve’s proper function along with the faulty Mitral Valve are removed, and they will then sew the replacement valve into the space where the old valve was located. 

The surgeon confirms that the new valve is functioning. After which, the blood flow to the heart is restored. The surgery is done while the patient is on a Cardiopulmonary Bypass or CPB.

Possible complications of Mitral Valve Replacement Surgery:

• Haemorrhage
• Blood clots
• Malfunction of the replacement valve
• Irregular heartbeats (arrhythmias)
• Infection
• Stroke
• Death

In most cases, Mitral Valve Replacement patients stay in the hospital for five to seven days. They might go home sooner if the operation was minimally invasive. 

During the first few days after a heart valve replacement, the patient will be provided with pain medication as needed. The staff will regularly evaluate blood pressure, respiration, and heart function. Depending on the rate of healing and the type of surgery performed, full recovery could take a few weeks to several months.

Infection is the most serious risk following surgery; thus, keeping incisions sterile is critical. If symptoms of an illness appear, contact a doctor immediately.

• fever
• chills
• tenderness at the incision site
• excessive drainage from the incision site

Follow-up check-ups are essential because they assist doctors in evaluating if the patient is ready to resume normal activities. A support system should be in place for the patient after surgery. Ask relatives and friends to help around the house and drive to medical appointments.

Reviewed by Dr. Balbir Singh, Chairman - Cardiac Sciences, Cardiology, Cardiac Electrophysiology - Pacemaker on 18-Jan-2023.