Replacement, mitral valve, with cardiopulmonary bypass
CPT4 code
Name of the Procedure:
Replacement, Mitral Valve, with Cardiopulmonary Bypass
(Mitral Valve Replacement, MVR)
Summary
Mitral valve replacement is a surgical procedure to replace a faulty mitral valve in the heart with a prosthetic valve. This is performed with the help of a heart-lung machine, also known as cardiopulmonary bypass, which takes over the function of the heart and lungs during the surgery.
Purpose
Mitral valve replacement addresses issues with the mitral valve, such as mitral valve stenosis (narrowing) or mitral valve regurgitation (leakage). The goal is to restore normal blood flow, improve heart function, and alleviate symptoms such as shortness of breath, fatigue, and heart palpitations.
Indications
- Severe mitral valve stenosis or regurgitation
- Symptoms such as breathlessness, chest pain, or swelling in the legs
- Ineffectiveness of medications or previous interventions
- Risk of heart failure due to valve dysfunction
Preparation
- Instructions to fast for 8-12 hours before the procedure
- Adjustment or discontinuation of certain medications, as advised
- Comprehensive diagnostic tests, including echocardiogram, chest X-ray, blood tests, and possibly a cardiac catheterization
- Meeting with the surgical team to discuss details and sign consent forms
Procedure Description
- Anesthesia: General anesthesia is administered to ensure the patient is asleep and pain-free.
- Incision: A midline incision is made through the sternum (breastbone) to access the heart.
- Cardiopulmonary Bypass: The heart-lung machine is connected to take over the circulatory function.
- Valve Replacement: The heart is temporarily stopped, and the damaged mitral valve is removed. A new prosthetic valve, either mechanical or bioprosthetic, is sewn into place.
- Completion: The heart is restarted, and the patient is gradually weaned off the heart-lung machine.
- Closure: The incision is closed, usually with sutures or surgical staples.
Duration
The procedure typically takes between 3 to 5 hours.
Setting
The surgery is performed in a hospital operating room, specifically in a cardiac surgery suite.
Personnel
- Cardiothoracic surgeon
- Anesthesiologist
- Surgical nurses
- Perfusionist (operates the heart-lung machine)
- Surgical technologists
Risks and Complications
- Common risks: bleeding, infection, blood clots
- Rare risks: stroke, heart attack, prosthetic valve dysfunction, arrhythmias
- Complications may include prolonged mechanical ventilation, renal issues, or the need for reoperation
Benefits
- Relief from symptoms like breathlessness and fatigue
- Improved heart function and quality of life
- Long-term regulation of blood flow through the heart
Recovery
- Hospital stay of about 5-7 days post-surgery, including ICU monitoring
- Pain management with medications
- Gradual increase in physical activity
- Avoidance of heavy lifting for 6-8 weeks
- Follow-up appointments for monitoring the prosthetic valve and overall heart health
Alternatives
- Mitral valve repair (if feasible)
- Medications to manage symptoms
- Minimally invasive transcatheter mitral valve replacement (TMVR) for high-risk surgical candidates
- Pros and cons: Surgical replacement provides a definitive and often long-term solution, whereas some alternatives may have shorter recovery times but may not be suitable for all patients.
Patient Experience
During the surgery, the patient will be under general anesthesia and will not feel any pain. Post-surgery, the patient may experience soreness, fatigue, and mild pain managed with medications. Rehabilitation and gradual return to daily activities are part of the recovery process, ensuring the best possible outcomes.