Mitral Valve Replacement
Mitral valve replacement is an open heart procedure performed by heart surgeons to treat mitral valve conditions such as “Blockage”(stenosis) or less commonly, complex forms of “leakage” associated with infection, scarring (retraction of the leaflets), calcification or tumors. Mitral valve replacement is indicated for conditions where a mitral valve repair is not feasible or the result is suboptimal. Modern techniques include the preservation of the sub-valvular apparatus (fibrous bands holding the leaflet to the ventricular heart chamber) resulting in outcomes similar to valve repair in most patients.
The approach to expose the heart and mitral valve for the operation is the same as for mitral valve repair, and a less invasive operation (“small incision”) is indicated in most patients
A new valve (“prosthesis”) is placed after excision of the diseased native valve (anterior leaflet) and preparation of the annulus and cordal attachments.
Heart valves have been introduced in the 1960’s and have improved dramatically since then. They have developed into excellent alternatives to replace the valves whenever repair is not possible. Nowadays, they have excellent hemodynamics, profile and durability. There are 2 major types of valves:
Mechanical valves are made of poli-carbon graphite alloys and have mobile leaflets to allow forward flow and prevent backward flow into the heart. They have different sizes to match the human variations. With few exceptions, they don’t need re-replacement. They are indicated in younger patients (< 60 years). To avoid clotting and to maintain normal functioning, these valves require life-long anticoagulation (“blood thinners”).
Biologic valves are made with porcine tissue (“pig valves”) or bovine tissue (“pericardial valves”) mounted on a frame of cloth and wire alloy. Although short lasting in the past (< 10 years), modern technology applied to newer generation valves have resulted in longer durability (greater than 15 years) in most patients. The animal tissue is treated with glutaraldehyde and anti-calcification methods that blunt a rejection response and avoids calcium deposition, therefore decreasing the need for early re-replacement. These family of valves don’t require the routine use of blood thinners, but only a baby aspirin daily.