When Can A Patient Get Off Of Blood Thinners After A Mitral Valve Repair

written past Mustafa Ahmed Physician and David Mcgiffin Medico

Mitral Valve Replacement vs Mitral Valve Repair – When should the mitral valve exist repaired and when should the mitral valve be replaced?

Determination making in valvular middle illness is complex. Performance may be required for mitral regurgitation, mitral stenosis, or both. Mitral regurgitation is a leaky mitral valve. Mitral stenosis is a tight mitral valve. The key is that all decisions regarding operations on the mitral valve be discussed with dedicated specialists with a proven track-record of successful mitral valve surgeies. Unfortunately, in the Us many valves that could exist repaired are replaced, just considering of a lack of experience and involvement in mitral valve repair by the surgeons involved. In many circumstances, in that location is a articulate advantage of mitral valve repair over replacement. In that location are cases; yet, where mitral valve replacement will be the preferred method. Again, the key is that cardiologists and cardiac surgeons with a special interest in mitral valve illness make these decisions.

Should I get a metallic or a tissue mitral valve?

Many factors need to be taken in to account before deciding on the type of prosthetic heart valve. Information technology's important to take in to account the preference of the patient and how the choice volition affect lifestyle. For example, a tissue valve does not require long-term claret thinning medication, whereas a metallic valve does. Therefore, patients with a lifestyle that may include sports or other activities that would preferably avert blood-thinning medication may benefit from a tissue valve.

There are advantages and disadvantages to both types of valve. Metallic valves take the advantage of lasting a long fourth dimension and are generally not subject field to wear and tear over time. This of course means that the adventure of needing a further functioning is depression. The major disadvantage to a metallic mitral valve replacement is the demand for blood thinning medication, typically in the form of a Coumadin blood thinner. Patients with metallic valves demand their claret to be 2-3 times thinner than usual to avoid the risk of jell formation on the valves. Formation of a jell can atomic number 82 to stroke or valve dysfunction. Of class when the blood is thinner, there is an increased risk of haemorrhage.

Tissue valves have the advantage of not requiring long-term blood thinner. The major disadvantage of tissue valves is the fact that they will wear and tear over time and somewhen require farther mitral valve surgery. This may not be a business organisation for an fourscore twelvemonth-one-time, as it is not even known if they will be suitable for reoperation when they are over ninety years erstwhile. It is, however, an issue for someone in their 40'south, who would be in their fifty's when another valve is required.

The whole decision of tissue vs. metallic mitral valve replacement is getting even more interesting given the development of minimally invasive techniques such equally TAVR by which a valve replacement can exist performed without the need for open heart surgery. These valves can be placed within existing tissue valves, but non metallic valves. As of at present, this is still early engineering science and shouldn't influence controlling regarding the choice of mitral valve replacement. Fifty-fifty more interesting is the development of super minimally invasive techniques such every bit the mitraclip for mitral regurgitation.

The electric current guidelines make some general recommendations that can be helpful.

The choice of mitral valve replacement needs to be a shared decision between patients and specialists with multiple medical and lifestyle factors taken in to consideration.
Patients who cannot tolerate or for some reason do non want to consider the utilise of blood thinning medication should have a tissue mitral valve replacement recommended.
In general, in patients below 60 years of historic period, who are able to tolerate claret-thinning medication, a mechanical mitral valve replacement is reasonable. In patients over lxx years of age, a tissue valve is considered reasonable. In those between threescore-70, either is considered reasonable.

Fifty-fifty though the valve has been replaced, it's important to realize that mitral valve replacement patients have significant heart illness and require close follow-up care and attention to detail after the mitral valve replacement. Many patients undergoing mitral valve replacement accept accompanying problems such as middle failure, other valve disease, and pulmonary hypertension (high pressures in the lung arteries) that volition crave ongoing management.

How oft will valve replacement patients have to come across their middle doc?

This depends on factors such as other ongoing health issues, the blazon of valve and other factors that volition be determined by the MD or DO in charge of your care. Later the surgery and the hospital belch, patients volition follow upwardly with the surgeon in the 1-two weeks after the mitral valve replacement to ensure in that location are no immediate problems from the surgery and that everything is going well. Moving forrad the cardiologist may see patients in weeks to months afterwards the surgery. If all is well, mitral valve replacement patients typically are seen on a yearly footing.

Patients with metallic valves will require bank check for event of blood thinning medications.

For those patients with metallic valves, information technology'due south important to pay close attention to blood tests such as the INR, that monitor the response to Coumadin blood thinner. This is important, because information technology prevents the valve from developing clots that tin lead to strokes or valve failure.

How often do metallic mitral valve replacement patients demand imaging studies?

If all goes well later on surgery and the patient is doing well without bug, there is normally a yearly follow up to assess how the patient is clinically doing. Afterwards surgery there will exist an echocardiogram performed to ensure normal valve functioning. This is unremarkably done in the weeks to months after mitral valve replacement and is also important to establish a baseline. Stable patients don't require routine follow-up imaging. Later this point, imaging is only typically required if there is a change in the clinical status, i.e. development of symptoms, or a new finding on the physical exam such equally an increasing murmur.

How often do tissue (i.e. creature) mitral valve replacement patients demand follow up imaging?

This is slightly different for patients with metallic valves. Tissue valves are subject to degeneration over time. Degeneration isn't likely in the first ten years later a tissue mitral valve replacement. But, afterwards this it is increasingly likely to occur with each year that passes. For this reason information technology is recommended that later x years, fifty-fifty if there are no symptoms or clinical signs of concern, that an echocardiogram is performed to assess the valve. It is very important that patients with tissue mitral valve replacement are educated to report signs and symptoms such every bit shortness of breath, dizziness, swelling etc. and then they tin be evaluated in a timely fashion.

What tests are needed earlier mitral valve replacement surgery?

Typically nigh patients have had an ultrasound scan of the heart known as an echocardiogram before they are sent to a surgeon. For patients with risk factors for coronary artery disease, and in general those over 35-forty, a coronary angiogram will be performed to ensure there are no centre avenue blockages that need bypassing at the time of valve replacement.

How long will the mitral valve replacement operation take?

In general the whole process in and out the operating room takes two-4 hours. It besides depends on whether there are other things being fixed, such as additional valve or bypass surgery. The usual time from stopping the heart to getting the heart chirapsia again is around 45 minutes. After that the diverse tubes are removed, and the center is check to ensure at that place is no bleeding. Finallu, the chest is airtight.

How long practise patients demand to stay in hospital?

A lot depends on the patient and how quickly they are upwards walking. If things get well and the patient is up and walking within a few days, the usual hospital stay will be roughly v days.

When can patients go back to work after a mitral valve replacement?

This of course depends on the job. Most patients tin can be driving within 2 weeks of leaving hospital. If they are involved in heavy manual work, and so it'southward advised they avoid any type of heavy work for 8. If it's a desk job, for instance, so patients tin basically go back to work whenever they experience similar information technology, although its advised non to start with a full twenty-four hour period. With robotic heart surgery the recovery time is likely to be more rapid.

Are there any special restrictions subsequently mitral valve replacement?

Patients with valve replacement should be sure to enquire about antibiotic prophylaxis before sure procedures to assistance preclude infection from reaching the middle. Also in patients with metallic valves who are taking blood-thinning medicines, activities with more than an ordinary take a chance of injury should be avoided due to the chance of hemorrhage.

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