Mitral valve repair and mitral valve replacement

Date Updated: 09/29/2021

Overview

Mitral valve repair and mitral valve replacement are types of surgery to fix or replace a leaky or stiff mitral valve in the heart. The mitral valve is between the left heart chambers (left atrium and left ventricle).

Mitral valve repair and mitral valve replacement may be done as an open-heart surgery procedure or as minimally invasive heart surgery. Sometimes a mitral valve problem may be treated with a catheter-based procedure. The specific procedure used depends on the severity of your mitral valve disease and whether it's getting worse.

Why it's done

Surgery or another procedure to repair or replace a mitral valve may be done if you have mitral valve disease such as:

Mitral valve regurgitation. The flaps (leaflets) of the mitral valve don't close tightly, causing blood to leak backward. Mitral valve regurgitation is common in people with mitral valve prolapse. Mitral valve repair surgery is recommended if you have severe mitral valve regurgitation symptoms.
Mitral valve stenosis. The valve leaflets become thick or stiff, and they may fuse together. This causes the valve to become narrowed and reduces blood flow through the area.

If your condition is mild, your doctor may first suggest regular checkups to monitor your heart health. You may be prescribed medications to manage symptoms.

Sometimes mitral valve repair or mitral valve replacement is done even if you're not having symptoms. Research has found that performing surgery in some people with severe mitral valve regurgitation who aren't having symptoms — rather than monitoring the condition — can improve long-term outcomes.

For people with mitral valve disease, Mayo doctors may often recommend repairing the mitral valve when possible, as it preserves the mitral valve and may preserve heart function. Mitral valve repair may be done to avoid complications that can occur with mitral valve replacement, such as blood clots due to mechanical valves and biological tissue valve failure.

Risks

Possible risks of mitral valve repair and mitral valve replacement surgery include:

Bleeding
Blood clots
Valve dysfunction in replacement valves
Heart rhythm problems
Infection
Stroke
Death

How you prepare

Your doctor may order several tests to get more information about your heart condition, including an echocardiogram.

Before the procedure to have your mitral valve repaired or replaced, your doctor and treatment team will explain to you what to expect and discuss any concerns you may have.

As you prepare for mitral valve repair or replacement, it can be helpful to talk to your loved ones about your hospital stay and what help you may need when you return home. Your doctor and treatment team will give you specific instructions to follow during your recovery at home.

Food and medications

Talk to your doctor about:

When you can take your regular medications and whether you can take them before your surgery
When you should stop eating or drinking the night before the surgery

Clothing and personal items

Your treatment team may recommend that you bring several items to the hospital, including:

A list of your medications
Eyeglasses, hearing aids or dentures
Personal care items, such as a brush, a comb, a toothbrush and shaving equipment
Loosefitting, comfortable clothing
A copy of your advance directive
Items that may help you relax, such as portable music players or books

During surgery, avoid wearing:

Jewelry
Eyeglasses
Contact lenses
Dentures
Nail polish

Precautions regarding medications and allergies

Talk to your doctor about:

Any medications you have brought to the hospital and when you should take medications on the day of the procedure
Allergies or reactions you have had to medications

What you can expect

Mitral valve repair and mitral valve replacement are done by a heart (cardiac) surgeon. Some people with mitral valve problems may be treated with catheter-based procedures performed by an interventional cardiologist.

If you need heart surgery for another condition in addition to mitral valve disease, your doctor may perform both surgeries at the same time.

Before

You'll receive medication to put you into a deep sleep during the procedure (general anesthesia). You'll be connected to a heart-lung bypass machine, which keeps blood moving through your body during the procedure.

During

Minimally invasive heart surgery generally should be done at medical centers with medical teams experienced in performing these types of procedures.

Mitral valve procedures may be done in the following ways:

Open-heart surgery, which involves a cut (incision) in the chest.
Minimally invasive heart surgery, which uses smaller incisions in your chest. Minimally invasive heart surgery may involve a shorter hospital stay, quicker recovery and less pain than open-heart surgery.
Robot-assisted heart surgery, a type of minimally invasive surgery in which the surgeon sits at a remote area and views the heart on a video monitor. The surgeon uses robotic arms to perform the same movements used in open-heart surgeries. Robotic mitral valve replacement is becoming more common as a surgery option. Together, you and your surgeons will discuss the best surgery option for you.
Transcatheter procedure, which is done by a cardiologist in the catheterization lab. This type of treatment involves inserting a catheter in a vein and guiding it to the heart. The catheter may be used to deliver tools to repair or replace the valve.

Mitral valve repair

During mitral valve repair surgery, your doctor may:

Patch holes in a heart valve
Reconnect the valve leaflets
Remove excess tissue from the valve so that the flaps can close tightly
Repair the structure of the mitral valve by replacing cords that support it
Separate valve leaflets that have fused

Other mitral valve repair procedures include:

Annuloplasty. Surgeons tighten or reinforce the ring around the valve (annulus). Doctors may perform annuloplasty alone or with other techniques to repair a heart valve.
Valvuloplasty. This catheter procedure is used to repair a mitral valve with a narrowed opening. It may be done even if you don't have symptoms. The doctor inserts a catheter with a balloon on the tip into an artery in your arm or groin and guides it to the mitral valve. The balloon is inflated, widening the mitral valve opening. The balloon is deflated, and the catheter and balloon are removed.
Mitral valve clip. In this procedure, the doctor guides a catheter with a clip on its end to the mitral valve through an artery in the groin. The clip is used to fix a torn or leaky mitral valve leaflet. Your doctor may recommend this option if you have severe mitral valve regurgitation and are not a good candidate for mitral valve surgery.

Mitral valve replacement

During mitral valve replacement, your heart surgeon removes the mitral valve and replaces it with a mechanical valve or a valve made from cow, pig or human heart tissue (biological tissue valve).

In some cases, a heart catheter procedure may be done to insert a replacement valve into a biological tissue valve that is no longer working properly. This is called a valve-in-valve procedure.

After

If you've had mitral valve repair or replacement surgery, you'll generally spend a day or more in the intensive care unit (ICU). You'll be given fluids and medications through an IV. Other tubes will drain urine from your bladder and fluid and blood from your chest. You may be given oxygen.

After leaving the ICU, you'll be moved to a regular hospital room for several days. The time you spend in the ICU and hospital can vary depending on your condition and the type of surgery you have.

If you've had a transcatheter procedure, you will stay in the hospital at least overnight but may not need to stay in the ICU. With this approach, there are no tubes needed to drain fluid or blood from your chest.

Your doctors and nurses will monitor your condition and watch for signs of infection at your incision sites. You'll have your blood pressure, breathing and heart rate checked often. Your doctor will also work with you to manage pain you may have after surgery.

You'll be told to gradually increase your activity and to do breathing exercises as you recover. Your nurses will help you take longer and longer walks during your time in the hospital.

You'll be given instructions to follow during your recovery, which will include details about the following:

How to care for your incisions
What medications you should take and when
How to manage pain and other side effects
The signs and symptoms of infection and when to call your doctor

After mitral valve repair or mitral valve replacement, your doctor will tell you when you can safely return to daily activities, such as working, driving and exercise.

Results

Mitral valve repair and replacement surgery may help reduce symptoms and improve your quality of life.

You'll need regular checkups with your doctor to make sure the new or repaired valve is working properly.

If you had mitral valve replacement with a mechanical valve, you'll need to take blood thinners for the rest of your life to prevent blood clots. Biological tissue valves break down (degenerate) over time and usually need to be replaced.

Your doctor may also recommend cardiac rehabilitation, a program of education and exercise designed to help you improve your health and recover after heart surgery.

Following a healthy lifestyle is important to your heart health before and after mitral valve surgery. A healthy lifestyle includes:

Not smoking
Getting regular exercise
Eating a healthy diet
Managing stress