Return to Normal Activity After Mitral Valve Repair
Patients can resume normal activities without physical restrictions 2 weeks after mitral valve repair, with heavy lifting titrated to pain tolerance. 1
Immediate Post-Discharge Period (First 2 Weeks)
Standard sternal precautions are unnecessary for thoracotomy patients undergoing minimally invasive mitral valve repair. 1 This represents a significant departure from traditional cardiac surgery recovery:
- Physical restrictions on upper extremity range of motion are relaxed immediately upon discharge 1
- Patients may resume driving once they have ceased taking oral narcotics 1
- No physical restrictions apply after 2 weeks 1
For patients undergoing conventional sternotomy approaches, the timeline differs slightly. The sternum requires adequate healing before progressing to more strenuous activities, though specific restrictions are less stringent than previously thought. 1
Sexual Activity Resumption
Sexual activity can be resumed within days after discharge, provided exercise tolerance is adequate. 2 The practical assessment is the ability to climb one flight of stairs without difficulty, which indicates sufficient cardiovascular capacity. 2
Exercise Training and Cardiac Rehabilitation
Early exercise training after mitral valve repair is both safe and highly effective, and should begin approximately 16 days post-operatively. 3 This recommendation is supported by a multicenter prospective study of 251 patients that demonstrated:
- No occurrence or worsening of mitral regurgitation after early exercise training 3
- Peak oxygen consumption increased by 22% (from 16.3 to 20.0 mL/kg/min) 3
- Anaerobic threshold improved by 16% 3
- Left ventricular ejection fraction slightly increased (53% to 55%) 3
A multidisciplinary rehabilitation program should be available for all patients undergoing valve surgery. 1 Good candidates for exercise training include patients with normal left ventricular function after successful mitral valve repair. 1
Selected patients should undergo a submaximal exercise test about 2 weeks after surgery to guide detailed exercise recommendations. 1 This is particularly important because exercise tolerance after mitral valve replacement is much lower than after aortic valve replacement, especially if residual pulmonary hypertension exists. 1
Return to Work
Patients undergoing robotic mitral valve repair return to work significantly faster than those undergoing conventional approaches (median 33 days versus 54 days). 4 However, both approaches result in excellent functional quality of life outcomes within the first 2 years. 4
Important Caveats and Pitfalls
The approach matters significantly for recovery timeline. Minimally invasive approaches (lower hemisternotomy, direct-vision right minithoracotomy, or endoscopic right minithoracotomy) allow for accelerated recovery with discharge expected by postoperative day 3 or 4. 1
Avoid unnecessarily restricting activity based on outdated sternotomy precautions. For thoracotomy patients, standard sternal wound precautions do not apply. 1
Do not delay exercise training due to concerns about valve integrity. The multicenter French study definitively demonstrated that early exercise training does not deteriorate surgical outcomes and is highly beneficial. 3
Monitor for recurrent pleural effusions. Aggressive diuresis should be maintained for 3 to 5 days while hospitalized to reduce the risk of recurrent pleural effusions, which is a common reason for readmission. 1
Ensure appropriate anticoagulation management if indicated. Patients with mitral valve repair involving prosthetic annuloplasty rings require anticoagulation for the first 3 months, and those with atrial fibrillation require lifelong anticoagulation. 1