India has excelled in cardiac care, especially in advancing mitral valve replacement techniques. Thanks to modern medical facilities and a growing cadre of highly skilled cardiac surgeons, India has become a global centre for mitral valve treatments. Whether it's minimally invasive procedures or the latest in surgical innovations like robot-assisted and transcatheter interventions, Indian hospitals offer a wide range of options for patients with mitral valve disorders. These breakthroughs enhance patient outcomes and drive forward cardiac research and development. With its commitment to quality care at affordable prices, India stands at the forefront of mitral valve replacements, offering hope to patients worldwide.

What is a Mitral Valve? 

One of the four valves of the human heart, the mitral valve is situated between the left ventricle and the left atrium. In order to stop blood from returning to the atrium during ventricular contraction, it controls blood flow from the left atrium to the left ventricle. This valve, which has two leaflets or cusps, is essential for preserving healthy circulation because it ensures blood flows through the heart in the right direction.

What is Mitral Valve Surgery? 

Mitral valve surgery is a medical procedure performed to repair or replace the mitral valve in the heart.

This surgery is typically done to treat conditions that affect the mitral valve, such as mitral valve regurgitation (leaking of blood backwards through the valve) or mitral valve stenosis (narrowing of the valve).

There are two primary kinds of surgery for the mitral valve:

1. Mitral Valve Repair: This approach aims to preserve the patient's own valve tissue whenever possible. During mitral valve repair surgery, the surgeon may reshape, tighten, or reinforce the existing valve structures to improve their function and eliminate any leakage or obstruction. Repair techniques can include sewing a ring around the valve (annuloplasty), reattaching or replacing torn or damaged valve leaflets, or repairing the chordae tendineae (the fibrous cords that anchor the valve leaflets to the heart muscle).

2. Mitral Valve Replacement: In cases where the valve damage is too severe for repair, or if repair is not feasible, the mitral valve may need to be replaced with an artificial valve. This replacement can be done using a mechanical valve made of durable materials like metal or plastic, or a biological valve derived from human or animal tissue. Biological valves may wear out over time but typically do not require lifelong blood-thinning medication like mechanical valves.

Mitral valve surgery can be performed through traditional open-heart surgery or minimally invasive techniques, depending on factors such as the patient's overall health, the severity of the valve condition, and the surgeon's expertise. Restoring optimal valve function, enhancing heart function, reducing symptoms, and improving the patient's quality of life are the objectives of mitral valve surgery.

Indications for Mitral Valve Replacement Surgery:

Mitral valve replacement surgery is typically recommended for patients with severe mitral valve disease, including:

• Mitral valve stenosis (narrowing of the valve opening)
• Regurgitation of the mitral valve, or blood flowing backwards through the valve
• Mitral valve prolapse (bulging of the valve into the left atrium)

These conditions can be caused by congenital defects, rheumatic fever, infective endocarditis, or degenerative changes associated with ageing.

Surgical Techniques: 

Mitral valve replacement surgery can be performed using either traditional open-heart surgery or minimally invasive techniques, depending on the patient's condition and the surgeon's expertise.

In open-heart surgery, the surgeon makes an incision in the chest, exposes the heart, removes the diseased mitral valve, and replaces it with a mechanical or biological prosthetic valve.

Minimally invasive approaches involve smaller incisions, specialized instruments, and sometimes robotic assistance, resulting in shorter hospital stays, faster recovery, and reduced post-operative pain.

Procedure using a catheter, carried out in the catheterization lab by an interventional cardiologist. A small, flexible tube called a catheter is inserted into a vein and guided to the heart during this form of treatment. Tools for mitral valve replacement or repair may be delivered through the catheter.

The Preparation 

Patients undergo a thorough evaluation before mitral valve replacement surgery to assess their overall health, cardiac function, and suitability for surgery. They include;

• Physical examination
• Echocardiography (to assess the structure and function of the heart)
• Electrocardiogram (ECG) and other cardiac tests
• Blood tests
• Imaging procedures (MRIs and CT scans, for example)

Anesthesia and Incision:

Mitral valve replacement surgery is performed under general anesthesia to ensure that the patient remains unconscious and pain-free throughout the procedure. Once the patient is anesthetized, the surgeon makes an incision in the chest, typically along the sternum (breastbone), to access the heart. In minimally invasive approaches, smaller incisions may be made between the ribs, depending on the surgical technique and the patient's anatomy.

Cardiopulmonary Bypass:

To facilitate the surgical repair or replacement of the mitral valve, the patient's blood circulation is temporarily rerouted through a heart-lung bypass machine, also known as cardiopulmonary bypass. This machine takes over the function of the heart and lungs, oxygenating the blood and maintaining circulation while the heart is stopped to perform the surgery.

Valve Replacement:

With the heart temporarily stopped and blood flow diverted through the bypass machine, the surgeon gains access to the mitral valve. The diseased valve is carefully excised, and the annulus (the ring-shaped structure surrounding the valve) is inspected for abnormalities. The surgeon then selects an appropriate prosthetic valve—either mechanical or biological—and securely sutures it into place within the mitral valve annulus.

Closure and Recovery:

Once the prosthetic valve is securely in place, the heart is gradually restarted, and blood flow is restored to its normal course. The incisions are meticulously closed, and the patient is transferred to the intensive care unit (ICU) or a cardiac recovery unit for monitoring and post-operative care. In the following days, the medical team closely monitors the patient's vital signs, cardiac function, and overall recovery progress, providing pain management, respiratory support, and physical therapy as needed.

Post-operative Care and Rehabilitation:

After mitral valve replacement surgery, patients undergo a period of recovery and rehabilitation to regain strength, mobility, and cardiac function. Medications, gradual physical activity, and regular follow-up appointments are needed for recovery after heart surgery.

Also, strictly follow a healthy lifestyle with regular exercise, consuming a healthy diet, managing stress and quitting smoking.

 Cost Analysis of Mitral Valve Replacement 

Upon analyzing the data provided in the table, it is evident that the cost of mitral valve replacement is comparably lower in India as compared to other prominent nations. Additionally, there are variations in the cost of treatment from city to city within India. The cost of treatment in Delhi is the most affordable in India. When compared to Turkey and Germany, Thailand is an excellent option for cost-effective treatment.

Top Hospitals for Mitral Valve Replacement Surgery 

• Medanta, The Medicity, Gurgaon
• Indraprastha Apollo Hospital, New Delhi
• Fortis Escorts Heart Institute, New Delhi
• Artemis Hospital, Gurgaon
• Jaypee Hospital, Noida
• Fortis Memorial Research Institute, Gurgaon
• Manipal Hospital (Old Airport Road) Bangalore
• Apollo Hospitals, Greams Road, Chennai
• Kokilaben Dhirubhai Ambani Hospital, Mumbai
• VPS Lakeshore Hospital, Kochi

Best Surgeons in Mitral Valve Replacement Surgery 

• Dr. Sandeep Attawar
• Dr. Naresh Trehan
• Dr. Ajay Kaul
• Dr. Anoop K.Ganjoo
• Dr. Sanjeev Jadhav
• Dr. Y K Mishra
• Dr Nandkishore Kapadia
• Dr Devi Prasad Shetty

 FAQ 

 1. How much does a mitral valve replacement cost in India?

 - The cost of mitral valve replacement is approximately Rs. 4,00,000 in India and can vary depending on factors such as the hospital, surgeon's fees, type of surgery (open-heart surgery or minimally invasive), and post-operative care.

 2. How can I schedule an appointment for mitral valve replacement surgery in India?

 - You can schedule an appointment for mitral valve replacement surgery in India by contacting the chosen hospital or cardiac centre directly. Many hospitals have dedicated departments or coordinators for cardiac surgeries who can assist you in scheduling appointments and providing necessary information.

 3. What is the success rate of mitral valve replacement surgery in India?

   - The success rate of mitral valve replacement surgery in India is high and comparable to international standards. The outcome may vary on factors such as the patient's overall health, the expertise of the surgical team, and adherence to post-operative care protocols. Consult with your surgeon for more specific information based on your case.

 4. What are the risks associated with mitral valve replacement surgery?

 - Mitral valve replacement surgery, like any major cardiac surgery, carries certain risks, including but not limited to:

- Bleeding

- Infection

- Blood clots

- Stroke

- Heart rhythm disturbances

- Rejection of the artificial valve (if a biological valve is used)

 5. How much time is required for the surgery?

 - The surgical procedure generally requires a duration of one to four hours to complete.

 6. How long is the recovery period after mitral valve replacement surgery in India?

- Recovering from mitral valve replacement surgery can take weeks to months depending on various factors, such as the type of surgery done, the patient's health, and post-operative care. Patients usually stay in the hospital for about a week and receive personalized care instructions from their medical team for rehabilitation.

 7. Does insurance cover mitral valve replacement surgery in India?

- Health insurance policies cover cardiac surgeries, but coverage can vary. Check with your insurance company for coverage specifics and hospitals for financing options.