Mitral Valve Repair

Written with A. Marc Gillinov, MD

• Advantages of Mitral Valve Repair
• Minimally Invasive Mitral Valve Repair
• Mitral Valve Repair Surgical Techniques
• Mitral Valve Repair Special Situations

Mitral Valve Repair at Cleveland Clinic

Cleveland Clinic heart surgeons have the world’s greatest experience with mitral valve repair, the best option for most patients with a leaking mitral valve (mitral regurgitation).

At Cleveland Clinic, nearly all leaking mitral valves are repaired rather than replaced, providing patients with ideal outcomes. The majority of these operations are performed minimally invasively, ensuring rapid recovery.

In 2009, patients traveled to Cleveland Clinic from all 50 states and 103 countries for their cardiovascular care.

Advantages of Mitral Valve Repair

Mitral valve repair is the best option for nearly all patients with a leaking (regurgitant) mitral valve and for many with a narrowed (stenotic) mitral valve.

Compared to valve replacement, mitral valve repair provides better long-term survival, better preservation of heart function, lower risk of complications, and usually eliminates the need for long-term use of blood thinners (anticoagulants). For these reasons, Cleveland Clinic surgeons are committed to mitral valve repair.

Advantages of Mitral Valve Repair:

• Better early and late survival
• Improved lifestyle
• Better preservation of heart function
• Lower risk of stroke and infection (endocarditis)
• No need for blood thinners (anticoagulation)

Your Mitral Valve

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Minimally Invasive Mitral Valve Repair

Cleveland Clinic surgeons are pioneers in the development of minimally invasive techniques for mitral valve repair. Today, nearly all mitral valve repairs can be performed through a 2-3 inch incision on the right side of the chest. This approach may also include the use of a surgical robot, which allows an even smaller incision.

A second minimally invasive approach through the center of the chest is available for selected patients whose anatomy is best addressed through this incision. Minimally invasive approaches may also be used for patients who require aortic valve or tricuspid valve surgery, alone or in combination with mitral valve surgery. In addition, Cleveland Clinic is a leader in research into percutaneous (through the skin) approaches to mitral valve repair, which may lead to additional treatment options in the future.

Learn about minimally invasive mitral valve repair: types of incisions, surgical options, photos and videos

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Mitral Valve Repair Surgery — Surgical Techniques

Cleveland Clinic surgeons have been instrumental in the development and application of modern mitral valve repair techniques. Problems with the posterior leaflet are generally corrected by a small resection of the abnormal portion of the valve. Anterior leaflet dysfunction is managed by creation of new chords or chordal transfer. Anterior leaflet repair techniques are technically challenging, requiring a skilled and experienced surgical team to achieve the best result. All repairs include an annuloplasty, which is a complete or partial ring placed around the circumference (rim) of the valve.

Mitral Valve Posterior Leaflet Prolapse — Valve Repair Surgery

During mitral valve repair heart surgery, triangular resection is the technique used most frequently for posterior leaflet prolapse.

Triangular Resection Mitral Valve Repair

Ruptured chords at free edge of posterior leaflet. Region to be resected is indicated.

Abnormal segment has been removed. Leaflet edges are sewn together.

Annuloplasty completes the repair.

Mitral Valve Anterior Leaflet Prolapse — Valve Repair Surgery

When there is mitral valve prolapse of the anterior leaflet, repair is more complex and requires greater surgical expertise. Two techniques used for correction of anterior leaflet prolapse are the transfer of normal chords from another part of the valve (chordal transfer) and creation of artificial chords.

Chordal Transfer to Treat Anterior Leaflet Prolapse

Chordal transfer to correct anterior leaflet prolapse.

Posterior leaflet chordae are transferred to the unsupported free edge of the anterior leaflet. The posterior leaflet is repaired as after a quadrangular resection.

Gore-Tex^® Chord for Correction of Anterior Leaflet Prolapse

Chordae may be constructed from Gore-Tex^® sutures. A premeasured loop of Gore-Tex^® is affixed to the head of the papillary muscle with a pledgetted suture. The loop is then attached to the free edge of the unsupported anterior leaflet, providing support.

Long-term durability is excellent. The new chordae do not rupture or elongate.

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Mitral Valve Repair — Special Situations

Mitral Valve Repair and Atrial Fibrillation

Many patients with mitral valve disease have atrial fibrillation, (an abnormal heart rhythm.) For these patients, at the time of minimally invasive mitral valve repair, Cleveland Clinic surgeons perform an ablation (Maze procedure) with the intent of curing the atrial fibrillation.

Previous Mitral Valve Repair with Recurrent Mitral Regurgitation

In rare instances, a mitral valve repair may fail over time. While most surgeons replace such valves, Cleveland Clinic surgeons can frequently re-repair these valves, offering excellent long-term durability and the important advantages that go with mitral valve repair.

Previous Heart Surgery with Recurrent Mitral Regurgitation

Occasionally, a patient who has had previous bypass surgery, aortic valve surgery or other heart surgery develops a new problem with the mitral valve. In these re-operative settings, Cleveland Clinic surgeons can safely and effectively repair nearly all leaking mitral valves.

Mitral Valve Repair for Endocarditis

When infection damages a mitral valve (endocarditis), repair is particularly challenging. Because of their extensive experience with such patients, Cleveland Clinic surgeons successfully repair the mitral valve in the majority of patients who have had endocarditis.

Mitral Calcification

Occasionally, a patient with mitral regurgitation has extensive calcium deposits on the valve leaflets or annulus. The calcium makes repair difficult and requires application of advanced surgical techniques and sound judgment. Cleveland Clinic surgeons have the expertise to ensure excellent outcomes in patients with calcified mitral valves.

Cleveland Clinic surgeons have performed nearly 13,000 mitral valve repairs, the largest number of any institution. In 2009, operative mortality for primary isolated mitral valve repair was 0%, compared with The Society of Thoracic Surgeons' (STS) benchmark of 1.1%.

• Learn more about Cleveland Clinic Mitral Valve Surgery outcomes.

Mitral Valve Repair Surgery Videos

View the following valve surgery videos: (page may take a couple minutes to load)

• Mitral valve repair by posterior leaflet resection
• Mitral valve repair by sliding leaflet repair
• Mitral valve repair by chordal transfer to treat anterior leaflet prolapse
• Mitral valve repair by use of artificial chordae
• Mitral valve repair via right mini-thoracotomy
• Mitral valve repair via partial upper sternotomy

For More Information:

• Mitral valve repair frequently asked questions - answered by one of our expert surgeons
• Latest Innovations in Mitral Valve Surgery - Transcript of webchat with Dr. Gillinov 4/2007
• Our surgical outcomes
• Treatment options: heart valve surgery
• Valve surgery — past, present and future
• Heart surgery at Cleveland Clinic
• Valve surgery videos
• More Valve Surgery information

Resources:

• Gillinov AM, Blackstone EH, Alaulaqui A, Sabik JF, Mihaljevic T, Svensson LG, Houghtaling PL, Johnston DR, Lytle BW. Outcomes after repair of the anterior mitral leaflet for degenerative disease. Ann Thorac Surg 2008; 86(3):708-17.
• Gillinov AM, Blackstone EH, Nowicki ER, Slisatkorn W, Al-Dossari G, Johnston DR, George KM, Houghtaling PL, Griffin B, Sabik JF 3rd, Svensson LG. Valve repair versus replacement for degenerative mitral valve disease. J Thorac Cardiovasc Surg 2008 Apr;135(4):885-93, 893.e1-2. Epub 2008 Mar 4.
• Gillinov AM, Banbury MK. Pre-measured artificial chordae for mitral valve repair. Ann Thorac Surg 2007; 84(6):2127-9
• Gillinov AM, Svensson LG. Ablation of atrial fibrillation with minimally invasive mitral surgery. Ann Thorac Surg 2007;84(3):1041-2.
• Gillinov AM, Liddicoat JR. Percutaneous transvenous mitral annuloplasty. EuroIntervention 2007.
• Gillinov AM. Is ischemic mitral regurgitation an indication for surgical repair or replacement? J Heart Fail Rev 2006;11(3):231-239.
• Gillinov AM, Liddicoat JR. Percutaneous mitral valve repair.Seminar Thoracic and Cardiovasc Surg 2006 Summer;18(2):115-121.

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Reviewed: 07/2010

This information is provided by Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition.

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