Complete guide to mitral regurgitation surgery, don’t miss the best time!

Author: Zhang Haibo, Chief Physician, Beijing Anzhen Hospital, Capital Medical University

Reviewer: Wang Fang, Chief Physician, Beijing Hospital

The heart, as the pump of our life, carries the hope of life with every beat. However, when the heart's mitral valve, this important "door", cannot close, our life pump may face serious threats. Facing the challenge of mitral regurgitation, early diagnosis and appropriate treatment are crucial, and rehabilitation management is the key to ensuring the quality of life of patients.

1. Timing of surgery for mitral regurgitation

When faced with mitral regurgitation, treatment decisions are often based on the severity of the condition. Mild to moderate patients usually do not need immediate surgery and can be managed by taking oral medications to control blood pressure, and regularly monitor the progression of the disease through cardiac ultrasound examinations, especially Doppler ultrasound, which is a powerful tool for assessing the severity of mitral regurgitation. By quantifying indicators such as the area of ​​the regurgitant jet and the regurgitant fraction, doctors can accurately determine the degree of valve function damage and provide a scientific basis for formulating treatment plans.

Figure 1 Original copyright image, no permission to reprint

However, when the condition is upgraded to severe, that is, the regurgitant jet area exceeds 8-10 square centimeters, or the regurgitant area accounts for more than 40% of the left atrial area, or the regurgitant fraction exceeds 50%, or the regurgitant volume exceeds 60 ml, surgery becomes a necessary option. The best time for surgery should be before heart failure occurs to avoid irreversible damage to heart function.

2. Surgical options for mitral regurgitation

In terms of surgical options, valve repair is preferred over valve replacement, especially in experienced medical centers. Repair surgery can preserve the natural structure of the heart and has better long-term results. Repair surgery not only prolongs the life of the valve, but also reduces possible future complications. However, when the valve is too damaged, valve replacement becomes a necessary treatment.

Figure 2 Original copyright image, no permission to reprint

Artificial valves are divided into mechanical valves and biological valves, each has its own advantages and disadvantages. Patients need to make a choice based on their personal circumstances and doctor's advice.

Mechanical valves have a long lifespan, but patients need lifelong anticoagulation treatment, regular monitoring of coagulation indicators and adjustment of warfarin dose accordingly. In practice, some patients find it difficult to achieve long-term standardized anticoagulation, which can easily lead to complications such as bleeding or thrombosis.

The average service life of a biological valve is about 10 to 20 years. The specific service life is affected by the patient's underlying diseases such as diabetes, hypertension, hyperlipidemia and other factors. If not well controlled, it may accelerate the calcification or other lesions of the biological valve, thereby shortening its service life.

When a bioprosthetic valve develops calcification or other dysfunction, a second surgery is indeed required to replace the valve, but patients who undergo a first-time bioprosthetic valve replacement are usually older and face a higher risk of reoperation.

3. Surgical methods for mitral regurgitation

The choice of surgical method is equally important. Traditional open-chest surgery is performed through a median sternotomy incision to ensure the thoroughness of the surgery, but the recovery period is long and affects the integrity of the thorax. Minimally invasive surgery, such as intercostal incision surgery, has the advantages of fast recovery and beautiful appearance, but it requires higher technical skills from the doctor and is suitable for cases with simpler valvular lesions. For patients whose physical conditions do not allow open-chest surgery, minimally invasive interventional surgery becomes a new option. It has less trauma and faster recovery, and is especially suitable for elderly or weaker patients.

Figure 3 Original copyright image, no permission to reprint

In addition, for elderly or weak patients who are not suitable for another open-heart surgery but still need a second surgery to replace the bioprosthetic valve, with the development of medical technology, minimally invasive interventional valve-in-valve technology is available.

This technology can be performed while the heart is beating, without the need for thoracotomy and extracorporeal circulation, greatly reducing the risk of surgery, providing an effective treatment option for this special group of people, and effectively prolonging the lives of patients.

IV. Postoperative rehabilitation and life adjustment

A successful operation is only the beginning of treatment. Postoperative recovery is equally important. Patients are usually discharged from the hospital about a week after surgery, but full recovery takes two to three months. During this period, avoiding excessive fatigue and preventing infection are the key points, especially preventing infective endocarditis.

For moderate and severe patients, daily life needs to be adjusted, such as avoiding heavy physical activities, rationally planning non-strenuous physical activities, and controlling water intake to reduce the burden on the heart. Although there are no special dietary taboos, in the early stages of heart failure, it is necessary to control water intake, and sometimes even diuretics are needed.