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Ultrasound,ECG,Chest x-ray, CT imaging, Cardiac MRI, Cardiac Stress tests, Cardiac catheterisation, Magnetic resonance imaging, transesophageal ECG, angiogram, sats probe.

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A mitral valve replacement is a type of cardiac surgery that fixes or replaces a leaking or narrowed mitral valve. The mitral valve may also be damaged or diseased and may need to be replaced due to this.

When the mitral valve cannot be repaired it will be replaced with a mechanical valve or a bio prosthetic valve (made from animal tissue).

The mitral valve is between the two left heart chambers (atrium and ventricle), this valve flaps open and close to let blood pass through

Why it may be needed

Mitral valve regurgitation

Mitral valve surgery may be performed if the valves don’t close tightly, this then allows the blood to leak backwards causing a back-flow. When this happens it is called mitral valve regurgitation.

Mitral valve stenosis

This is when the valve becomes too thick and this can cause the valve to become narrowed or stick together. When this happens less blood can flow through the valve.

Mitral valve prolapse

This happens when the flaps of the mitral valve become floppy and not close tight enough, causing a back-flow of blood. When there is a lot of mitral valve back flow the heart can’t push enough blood out to the body.

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Patients who have had a mitral valve replacement will go straight to ICU from theatre (still intubated) before moving to a surgical ward.

Patients will stay in hospital for a few days receiving oxygen, fluids and pain medication. The length of the stay depends on their specific condition.

Recovery time for a mitral valve replacement is usually between 4 to 8 weeks, although it can take up to 3 months for a full recovery.

Patients may have a drain to remove fluid and blood from the chest.

Arrhythmias are very common after valve replacement. Patients may receive medications or a temporary pacemaker to stabilise their heart rhythm.

Patients will begin anticoagulation therapy (usually warfarin) to reduce the risk of a blood clot. They will likely need to take these medications for up to three months if receiving a biological valve. Mechanical valve replacements require lifelong medication.

For at least 6 weeks, patients are not able to lift heavy objects or do activities that strain the chest or upper arm muscles.

A few days after the procedure, patients should begin gentle walking, gradually increasing the length and intensity.

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preparing all the necessary instruments and equipment for surgery, including microscopes, lasers and endoscopes

providing the correct surgical instruments and materials to the surgeon

being responsible for all surgical instruments, equipment and swabs during the operation

acting as a link between the surgical team and other parts of the theatre and hospital

anticipating the requirements of the surgical team and responding effectively

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A basic run down of what happens during the procedure. 

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A basic run down of what happens during the procedure. 

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Before the surgery

The patient will have an appointment for a pre-assessment and they will be given instructions of what to do prior to the surgery, such as stopping certain medications, especially blood thinners, stop smoking, wash your body with an antimicrobial soap the night before surgery and adhere to the fasting criteria. Medications may also be given to the patient prior to the surgery if a certain condition needs to be treated.

During the surgery

Mitral valve replacement is commonly carried out under general anaesthetic as an open heart surgery. Once the patient has been prepped the surgeon will make a single incision down the middle of the patients chest. During the Mitral valve replacement the team will use transoesophageal echocardiography, which is imaging technology which helps with the surgery.

Steps that will take place in order for this surgery are,

1. General anaesthetic.

2. Basic monitoring will be provided and antibiotics will be given via an IV cannula.

3. The patient will be connected to a cardiopulmonary bypass machine, to connect this machine to the patient, two tubes will be inserted into 2 of the large veins, superior vena cava and the inferior vena cava, allowing the bypass machine to do its job. At some point in the surgery the patients heart will be stopped.

4. The surgeon will then make an incision in the patients chest, as well as a median sternotomy.

5. After these steps are made the surgeon will then made an incision to the left atrium revealing the mitral valve.

6. During the procedure the surgeon will save as much of the good tissue as possible, while removing the damaged/unhealth tissue. After the valve has been removed then the surgeon will proceed with attaching the new mitral valve.

7. When the valve is attached the surgeon will then check the valves leaflets can move freely, and that no tissue is in the way when the valve closes.

8. Finally the surgeon will then sew the left atrium and the patient will be eased off of the bypass machine.

Mitral valve replacement usually takes up to 4 hours to complete.

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Role of a anaesthetic ODP during mitral valve replacement 

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Role of a anaesthetic ODP during mitral valve replacement 

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help and support patients before and during anaesthesia

Prepare specialist equipment this includes

invasive monitoring equipment

airway management equipment

Maintain health and safety

Advocate for the patient

Contribute to treating patients in emergencies