Mitral Valve Replacement or Repair (MVR)

Mitral Valve Disease (MVD) presents itself basically in two forms. One is when the valve doesn’t close well, and shows regurgitation, and in that case we speak about mitral valve insufficiency. The regurgitation has several stages which are graduated from I to IV (very mild to severe). The second form of the Mitral Valve Disease (MVD) is when the valve doesn’t open well, and than we speak about mitral valve stenosis.  It can be also graduated from mild to severe. The causes of the Mitral Valve Disease can be different, and for every patient they should be discussed individually.
If your cardiologist thinks that you suffer on MVD (Mitral Valve Disease) he will make some tests to find diagnosis. One of them is Trans Thoracal Echocardiography (TTE). If there is an evidence of the valve disease the next examination, which is much more specific has to be done. That is Trans Esophageal Echocardiography (TEE). If this examination shows moderate to severe valve disease, which can be either stenosis or insufficiency, your cardiologist will send you to invasive diagnostic (Coronary Catheterization) to examine the status of coronary arteries and of course to evaluate and verify the diagnosis of the valve disease.
In the case that coronary catheterization shows high significant stenosis on the coronary arteries you will be advised to have heart surgery with combined procedures: mitral valve surgery and coronary bypass surgery.
After you decided, together with your cardiologist, that the best, and very often the only solution for you is the heart surgery, you can be sent to our Department for Cardiac Surgery.
Usually you have to present your TTE; TEE and catheterizations film with the letter of your cardiologist by the first meeting. At that time you should become the information about the operation, and the first impression about the whole procedure and its risks. The operative risk is individual, depends on the patient’s condition, on other diseases, and of course on the surgeon’s skill and experience (Please visit Operative Risk Calculator  if you want to calculate on your own). It is also important to become the information about the Valve Prosthesis, so you will be able to make a choice, together with your surgeon and your cardiologist, about this very important issue.
Today, in the mitral valve surgery in a case of the valve insufficiency, we can offer basically two surgical procedures. One is Mitral Valve Repair and the other one is Mitral Valve Replacement.  We believe that the repair of the valve should be tried in every such case, and only if it is impossible (because of the valve damage) or the result of the repair intraoperativly  is not good enough, one can proceed and go for the valve replacement in the same operative session.
If you decide to have the surgery in our department, you will be scheduled for the operation and you will be asked to come to the department approximately 5 days prior the operation date, to give the blood sample for the Blood Bank. If you don’t tell us that you want Bloodless Surgery, we can not start the operation without having 4 units of red blood cells prepared.
You will be admitted in the hospital one day before the scheduled operation. The admission should be done until 10:00, so there will be enough time to perform routine pre-operative tests. In the afternoon our cardiac-anesthetist will visit you and explain the anesthetic procedure. Also you have to sign you operations consent / conformation. In the evening your surgeon will visit you once again, so you can ask him if there are some more questions about the operation.  
In the evening before the operation you can not eat or drink after 22:00. The relatives and visitors have to leave your room after 21:00.
In the evening you have to take shower and get a klisma. From the anesthetist you will get some medicines to relax and sleep.
On the operations day you will take a shower once more, and the nurses will shave your legs and thorax. They will bring you to the operating theater where you will get the anesthesia.
After that, your surgical team will proceed with the operation. If everything goes smoothly, without complications the whole procedure will take about 4 hours. After that, you will be transferred to our Intensive Care Unit (ICU) where you will stay one or two first postoperative days. After the thorax tubes are taken out, you can be transferred to the surgical ward. At the meetings prior to surgery you can choose one or two bed room for your stay after the operation.
On the sixth postoperative day you will be discharged from the hospital. For the first 3 postoperative weeks we offer a Home Care Package. One week after hospital discharge you will have appointment for control, and after that further therapy should be carried on by your cardiologist, who will be informed about your operation and its results.