Mitral Valve Regurgitation Surgery: Repair or Replace the Valve?

Topic Overview

To treat mitral valve regurgitation surgically, the options are to repair or replace the mitral valve.

Repair of the heart valve may be recommended if it is likely that the valve can be repaired and that the repair will last a long time.

Valve replacement may be recommended if your mitral valve is seriously damaged and cannot be repaired.

The decision about whether to repair or replace a valve is based on many things, including your general health, the condition of the damaged valve, the presence of other health conditions, and the expected benefits of surgery. In some cases, the decision clearly may be in favor of repair or in favor of replacement.

When is valve repair recommended?

Repair for mitral valve regurgitation may be recommended based on a few things. These include whether the valve can be repaired successfully.

Repair is more successful if there is not a lot of damage to certain areas of the mitral valve flaps (leaflets) or to the tough fibers that control movement of the mitral valve leaflets (chordae tendineae).

Mitral valve repair is usually preferred if your valve is suitable for reconstruction and the surgeon has the appropriate level of experience and surgical skill.

The advantages of mitral valve repair include the following:

• It preserves your natural valve and its support (chordae tendineae). In general, the more of the natural valve that can be preserved during surgery, the better the results of the procedure.
• It prevents the need for lifelong anticoagulant medicine after valve replacement with a mechanical heart valve.
• It reduces the need for repeat valve surgery later in life.

When is valve replacement recommended?

Examples of serious damage or complicated conditions that might lead to mitral valve replacement include:

• Extensive ballooning of the mitral valve (rather than a single flap that puffs up).
• Severe hardening (calcification) of the valve.
• Prolapse (bulging) of the valve at an unusual location.
• Damage to the valve from infection (endocarditis).

Replacement surgery is usually preferred if you have a hard, calcified mitral valve ring (annulus) or widespread damage to the valve and surrounding tissue.

The disadvantages of mitral valve replacement include the following:

• A tissue valve may need to be replaced after a certain number of years.
• If you have a mechanical valve, you will take anticoagulant medicine for the rest of your life to prevent blood clots.

If you choose mitral valve replacement, your surgeon will preserve as much of the valve as possible. Doing so provides a greater chance of success after surgery. Keeping the valve's base intact reduces the amount of foreign structures to which the heart must grow accustomed after replacement surgery.

Transcatheter repair

A transcatheter procedure is a new way to repair a mitral valve. It does not require open-heart surgery. It is a minimally invasive procedure. A doctor uses catheters in blood vessels to insert a device in the valve. The device helps keep blood from leaking backward. This may relieve symptoms and improve quality of life. This procedure is available in a small number of hospitals. And it is not right for everyone. It might be done for a person who can't have surgery or for a person who has a high risk of serious problems from surgery.^{footnote 1}