Keyhole Mitral Valve Replacement & Repair Surgeries

Keyhole Mitral Valve Surgery

If you’ve been told you need mitral valve replacement or surgical repair, you might be picturing open heart surgery with its lengthy recovery and prominent scarring. But there is hope for a different, more innovative path forward.

At The Keyhole Heart Clinic, our clinical lead brings over 20 years of specialised expertise as a valve repair surgeon. Mr. Inder Birdi pioneered minimally invasive surgery techniques that prioritise your heart’s health and quality of life.

Explore our resources and discover how minimally invasive procedures can benefit your life with reduced impact.

What Is the Mitral Valve & Why Does It Matter?

The mitral valve is one of the main valves in your heart. This valve is located on the left side of the heart, between the atrium and ventricle.

It controls blood flow between your lungs and the rest of your body. It has two valve flaps, called leaflets, that open and close with each heartbeat. When your heart squeezes, the valve closes. When your heart relaxes, it opens to allow blood to flow in.

What makes the mitral valve work so well is the way it’s connected to the heart’s inner structures. Tiny strings called chordae anchor the valve leaflets to the heart muscle, helping them move together properly.

If any part of this system fails, it can cause the valve to leak, which puts strain on your heart and affects its ability to pump blood effectively.

When Mitral Heart Valve Surgery is Necessary

Mitral heart valve surgery is needed when the mitral valve fails to function correctly. Surgery can involve a minimally invasive mitral valve replacement or repair of the heart valve.

Common conditions requiring these types of valve surgery include:

1. Mitral Valve Regurgitation: This condition occurs when the valve fails to close fully, allowing blood to flow backwards into the left atrium. Over time, mitral valve regurgitation causes the heart chambers to stretch, leading to stunted heart function and irregular heart rates. Surgery is usually recommended if the leakage is severe or symptoms develop.
2. Mitral Valve Stenosis: This is when the valve opening is narrowed, limiting blood flow into the left ventricle. It raises pressure in the heart and lungs, causing shortness of breath and fatigue. Surgery is needed for severe cases that don’t improve with medicine.
3. Infective Endocarditis: An infection can damage the mitral valve, causing it to leak or fail suddenly. Surgery is often urgent to remove infected tissue and fix or replace the valve.
4. Severe Mitral Valve Prolapse: If the valve leaflets bulge into the left atrium and cause significant leakage that medicine cannot control, surgery is advised to prevent heart failure and other complications.

Your Suitability for Minimally Invasive Mitral Valve Repair or Replacement

To assess your suitability for keyhole heart valve surgery, we begin by reviewing your medical history and  essential tests:

• Echocardiogram
• Electrocardiogram (ECG)
• Coronary angiogram

Many patients who come to us have already undergone these tests, and usually, we simply need to obtain the images for review.

You will also need a CT scan to check:

• The health of your aorta (your body’s main blood vessel)
• Whether we can safely use micro-pipes in the groin to connect you to the heart-lung machine during surgery

This test only takes a few minutes and provides valuable insights into your overall health as well.

Once we have decided that you are suitable for keyhole mitral valve surgery, we will plan the surgery to occur as soon as possible, and certainly within two weeks of your assessment.

Minimally Invasive Mitral Valve Repair Surgery vs Replacement Valve

It’s normal to feel unsure about your options regarding your cardiac health. Should you repair the valve or replace it with a new valve? If replacing it, which type of valve should you choose?

We explain the key differences and help you make a more informed decision.

Mitral Valve Repair Procedure

If your valve is leaking but not calcified, repair is a better option than replacement.

Here’s why:

1. It lasts longer than a tissue (bioprosthetic) valve.
2. It preserves your heart’s natural function more effectively.
3. It helps you live longer compared to having the valve replaced.
4. It lowers the possible risks of needing a pacemaker after surgery.

It’s essential to ask whether your valve can be repaired rather than replaced. Ensure that your healthcare team carefully evaluates all available options.

Mitral Valve Replacement Surgery

It is always best to perform mitral valve repair whenever possible. However, if the valve needs to be replaced, then we still have many effective options that will improve the lives of patients with mitral valve disease.

Types of Replacement Valves

There are two main types of alternative valves:

Tissue Valve

These biological valves are manufactured from human or animal tissue, such as pig or cow tissue.

• Pros: Usually, there is no need for long-term thinners like warfarin unless you already need them for another reason (e.g. atrial fibrillation).
• Cons: Animal and human heart tissue tend to wear out more quickly, especially in the mitral position. They may need to be replaced again in the future.

Mechanical Valve

This is an artificial valve.

• Pros: Designed to last a lifetime.
• Cons: Requires taking warfarin (a blood thinner) for life, which means regular blood tests and managing bleeding risk.

Choosing the Right Valve Based on Age and Life Stage

Your age plays a significant role in determining the type of valve that is best suited for your mitral heart valve replacement surgery.

• Under 50: A mechanical valve is strongly recommended; you’re likely to outlive a tissue valve and would otherwise need more surgeries.
• 50 to 70: Often still better off with a mechanical valve for long-term durability, unless there are other considerations.
• Over 70: A tissue valve is usually the better option. It avoids the risks associated with warfarin, which can become more severe with age.
• Women under 50 considering pregnancy: If you’re planning to have children, warfarin (required with mechanical valves) can harm a developing baby during the first trimester. In these cases, we may recommend a tissue valve instead. If a mechanical valve is still the best option, you’ll need to switch to injectable thinners during pregnancy for safety.

How Is Keyhole Mitral Valve Repair Surgery Performed?

Keyhole mitral valve repair or replacement is minimally invasive and presents fewer risks than open-heart surgery. It is performed through a small incision over the right side of the chest between the ribs and does not require cutting any bone.

The wound heals within seven to 10 days and is cosmetically very appealing. This is the preferred technique for mitral valve repair keyhole surgery at The Keyhole Heart Clinic, and our preferred location is The London Clinic.

We do not use robotic arms, like the Da Vinci Robot, since we have become highly skilled in the use of specially designed surgical instruments to perform the surgery with extreme accuracy.

Using these instruments, and a 4K television monitor, we can achieve perfect results very quickly, with the resulting time on the heart-lung bypass machine being significantly shorter than with robotic surgery. We believe that this leads to a far superior recovery due to the lower risk of heart-lung bypass-related dysfunction.

We also avoid spreading the ribs apart, which means that the pain associated with surgery is minimal.

• Keyhole mitral valve repair: If you have a mitral valve leak, the mitral valve repair is usually performed by using a technique where any torn mitral valve strings are replaced using a Gor-Tex string or chord. Occasionally, we perform a triangular resection mitral valve repair of the abnormal part of the leaflet to fix the leak. After the leaflet is repaired, a ring is stitched into the heart to stabilise the shape of the mitral valve “doorway”.
• Keyhole mitral valve replacement surgery: When the mitral valve is calcified, it is better to replace the mitral valve with a tissue valve (pig or cow) or a metal valve.

Patients who undergo this surgery experience:

• Less pain
• Less risk of wound infection
• Healing in days rather than months
• Smaller scars
• Quicker recover

Recovery Time From Keyhole Mitral Valve Repair or Replacement

Your recovery period depends on whether you’ve had keyhole surgery or open heart surgery as part of your mitral valve replacement procedure. Most patients spend four to seven days in the hospital and are walking unaided by the time they go home.

After keyhole mitral surgery:

• Expect some fatigue for one to two weeks
• Most daily activities can resume early
• By week three, many can walk at least 1.5 kilometres a day
• Light exercise is usually fine from week four

You’ll have follow-up appointments with your surgeon and care team, during which your medications may be adjusted and vital signs taken.

If you’ve had open heart surgery through the breastbone, recovery will take longer. You’ll need to avoid heavy activity for at least twelve weeks to allow proper healing.

Cardiac rehab can help speed up recovery and support a safe return to a healthy lifestyle.

Watch Mr Birdi’s informative video series on your mitral valve options, where he explains the pros and cons of repairing versus replacing the mitral valve.