Last updated: 11/24/2009

Cardiac monitoring is instituted and general anesthesia is provided. The surgeon uses a sternotomy to access the heart and great blood vessels. Anticoagulation is given as cannulae are inserted into the large vessels of the heart, femoral vessels,...

or a combination. Cardiopulmonary bypass is instituted. The heart is arrested as the cross clamp is applied to the ascending aorta to stop blood flow through the organ. The surgeon opens the heart to visualize the mitral valve. He/she may expose the mitral valve by opening the right atrium and then opening the atrial septum. Another approach requires a large left atrium that can be opened directly, making the mitral valve visible.

Next, the surgeon cuts the diseased valve away from the valve annulus (outer ring). The annulus is sized so that the proper size of valve can be selected for the patient's anatomy. Sutures are applied around the valve annulus, the valve is sutured into place, and tied into position. The atrial septum is closed with suture or left to heal naturally, and the heart is closed with sutures.

Deairing of the heart is performed prior to removal of the cross clamp. When the cross clamp is removed, deairing continues to ensure that no air is delivered to the systemic circulation. At this time a transesophageal echocardiogram (TEE) may be used to test that the valve is functioning correctly and that the heart is free of air. Once the surgeon is satisfied that the valve is working correctly, cardiopulmonary bypass is terminated, anticoagulation is reversed, and the cannulae are removed from the vessels. The sternotomy is closed. Permanent stainless steel wires are used to hold the sternum bone together. The skin incision is closed with sutures, and sterile bandages are applied to the wound.

A heart valve is a structure within the heart that prevents the backflow of blood by opening and closing with each heartbeat. Replacement heart valves are either mechanical or biological tissue valves. For patients under the age of 65, the mechanical valve offers superior longevity, but the use of this type of valve requires that the patient take an anticoagulation drug for the rest of his/her life. The biological tissue valve does not require anticoagulation therapy, but this type of valve is prone to deterioration leading to reoperation, particularly in those under the age of 50. Women who may want to have children after a valve replacement should usually receive a biological tissue valve, because the anticoagulant (Coumadin/warfarin) most often prescribed for patients with mechanical valves is associated with fetal birth defects. Aspirin can be substituted for warfarin in certain circumstances.