Mitral Valve Repair

What is mitral valve repair?

Mitral valve repair is open-heart surgery that fixes problems with your mitral valve. This is the “door” that connects your heart’s left atrium and left ventricle. Your left atrium receives oxygen-rich blood from your lungs. The blood travels through your mitral valve to enter your left ventricle. Then, your left ventricle pumps it out to the rest of your body through your aorta.

Mitral valve disease makes it harder for your valve to do its job. Over time, this can lead to heart and lung damage. A repair can help you avoid or delay this.

If you have severe mitral valve disease, your provider may recommend open-heart surgery to repair or replace your damaged valve. They often prefer repair over replacement — especially when the valve leaks. This is because keeping your own valve offers more benefits and fewer risks.

If you need to have mitral valve repair, it’s important to learn why you need this surgery and what you can expect. Like all heart surgeries, mitral valve repair surgery has risks. But advances in technology continue to make this surgery safer and more effective.

What does it treat?

Mitral valve repair treats the following conditions:

• Mitral valve regurgitation. Your valve flaps don’t close all the way, allowing some blood to leak in the wrong direction. You may need surgery if your valve is very leaky or causes symptoms.
• Mitral valve stenosis. This is a narrowing of your valve opening that prevents enough blood from flowing through. You may need surgery if you have severe narrowing with severe symptoms or a very narrow valve opening. (Your provider may try other methods first, like balloon mitral valvotomy.)
• Mitral valve prolapse. People with this condition have mitral valve flaps that are too floppy or stretchy. About 6 in 10 mitral valve surgeries are for leaky valves from leaflet prolapse.

People who have mitral valve disease, particularly if the valve leaks, may need mitral valve repair surgery. You also may need surgery if your left ventricle isn’t pumping out enough blood to your body (left-sided heart failure) or your heart is enlarged.

If you have a mild form of the disease, you may not need surgery. Your provider may prescribe medications to manage your symptoms. But they’ll keep a close eye on your valve by using echocardiogram tests to check your heart regularly. You may need surgery later on to manage valve disease that’s getting worse or damaging your heart.

How should I prepare for mitral valve repair?

You’ll work with your provider and care team to prepare for your surgery. Be sure to follow your provider’s instructions. Your provider may tell you to:

• Stop taking certain medications in the weeks leading up to your surgery, which includes blood thinners (anticoagulants) like aspirin and warfarin
• Work with them to stop smoking
• Wash with an antimicrobial soap the night before your surgery
• Take certain medications on the day of your surgery
• Stop eating and drinking after a specific time on the day of your surgery

What happens during mitral valve repair surgery?

During mitral valve repair, your surgeon will fix one or more issues with your valve. In general, your surgery will follow these steps. Your provider will:

1. Give you anesthesia so you’ll be in a deep sleep during the procedure
2. Connect you to a cardiopulmonary bypass machine that will do the work of your heart and lungs during the surgery
3. Make an incision (cut) in your chest — the size of the incision depends on the surgical method
4. Put an annuloplasty ring around the valve (this ring is like a cloth washer that supports the valve and returns it to a more typical shape)
5. Repair your mitral valve using one or more surgical techniques (described below)
6. Check to see if your valve is fully repaired and make adjustments if needed
7. Disconnect you from the bypass machine so your heart and lungs can start working again
8. Perform a transesophageal echocardiogram (they use this to inspect your valve and confirm repair success)

What surgical techniques are used for mitral valve repair?

Providers use several different techniques for mitral valve repair surgery. Talk with your provider about what you can expect for your surgery.

Incisions (cuts)

Your surgeon has different options for making an incision, like making:

• A cut down the middle of your chest (full sternotomy)
• An incision in part of your chest (partial sternotomy)
• A smaller incision between two of your ribs (right thoracotomy)
• Several small incisions in different points between your ribs (robotic-assisted method)

Annuloplasty

Almost all mitral valve repairs include an annuloplasty. This means your surgeon places a complete or partial ring around the rim of your valve. The ring may be flexible or rigid. An annuloplasty makes your repair last for a long time.

Triangular or quadrangular resection

This is the technique surgeons use most often for posterior leaflet prolapse. Your posterior (back) leaflet and anterior (front) leaflet are the two flaps that make up your valve.

Your surgeon resects (removes) the damaged part of your leaflet and then sews the remaining edges together. Usually, surgeons can make a small, triangular cut to remove the damaged part. But if a larger area of your leaflet is diseased, your surgeon may need to make a rectangular cut to remove more tissue.

Chordal repair

Surgeons use this technique to repair both posterior and anterior leaflet prolapse. It involves replacing some of your chordae (chords), which are the tough, fibrous strings that support your mitral valve. Your surgeon removes the ruptured or elongated (too stretched out) chords. Then, they create and attach new chords.

Your surgeon may create new chords out of a tough, synthetic material called Gore-Tex®. Or your surgeon may take healthy chords from another area of your valve and put them in place of the damaged ones. This is called chordal transposition or chordal transfer. Both options provide excellent long-term results.

Advanced surgical techniques for calcium removal

If you have many calcium deposits on your valve leaflets or annulus, your surgeon will separate your leaflet from your annulus and remove the calcium deposits. Then, they’ll rebuild the damaged part of your valve using a patch or sutures.

What happens after mitral valve repair surgery?

After your surgery, you can expect to:

• Spend one or two days in the ICU, where your care team will keep a close eye on you, checking your pulse, breathing and other vitals
• Spend several more days in a hospital room to continue recovering
• Learn about cardiac rehab
• Learn how to care for your incision when you get home

Most people need to recover in the hospital for about a week after surgery to repair their mitral valve.

What are the benefits of mitral valve repair?

Mitral valve repair has several advantages over valve replacement. These include:

• Better chances of surviving the surgery and living a longer time afterward
• Better preservation of heart function
• Lower risk of complications like stroke and endocarditis
• No need for long-term use of blood thinners (anticoagulants)

Whenever possible, your provider will recommend a repair instead of a replacement. Repair is the better option for most people with mitral valve regurgitation.

But replacement surgery is a better option in some situations. It doesn’t take as long as repair surgery, and it’s less complex to perform.

Some people are candidates for procedures other than standard open-heart surgery. These include minimally invasive mitral valve repair and percutaneous interventions. Talk with your provider to see if one of these procedures makes sense for you. Your provider will consider many factors like your age and overall health condition to decide the valve repair method that’s best for you.

How successful is mitral valve repair surgery?

Mitral valve repair is successful in most cases. Reports have shown that 10 years later, nearly 94% of people don’t have significant mitral valve regurgitation. 

What are the complications of mitral valve repair?

Complications of valve surgery include:

• Abnormal heart rhythms (arrhythmias)
• Bleeding
• Heart block (heartbeat signal issue)
• Heart failure
• Infection
• Stroke

Talk with your provider about all possible complications and how to lower your risk.

What is the recovery time?

Recovery from mitral valve repair surgery usually takes four to eight weeks. Some people may need longer.

You’re probably wondering what life will be like after your mitral valve repair. You know you’ll need to spend some time in the hospital, and you might be planning on cardiac rehab. But what comes next?

The short answer is that recovery looks different for everyone. Your neighbor might’ve bounced back quickly and felt as good as new a month later. But maybe an old friend told you she didn’t feel back to normal for many months. And even then, it felt like a “new normal.”

If it takes you longer, it’s OK. Don’t compare your recovery to what others experience, and don’t push yourself to feel better right away.

Several factors impact your recovery. These include:

• The severity of heart disease before your surgery. It’ll take you longer to get your strength back if you had reduced heart function.
• Your general health going into surgery. Were you active or did health issues make that difficult? Conditions like heart failure and kidney failure can also make recovery a slower process.
• The surgical method. If you had a median sternotomy, it’ll take six to eight weeks for your breastbone to get strong again. Smaller incisions from minimally invasive surgery heal faster.

After you’re home from the hospital, set small and manageable goals. Get enough rest as you slowly return to your normal routine. You’ll have some limitations after mitral valve repair while you recover.

Your provider will tell you when it’s safe for you to:

• Drive
• Lift heavy objects
• Take gentle walks or do other types of exercise

Follow-ups after mitral valve repair

You’ll need an echocardiogram each year so your provider can check on your valve function. You may also need antibiotics before certain procedures to prevent endocarditis (an infection of your valve).

How long does a mitral valve repair last?

Mitral valve repair is a durable solution for treating mitral valve disease. Most people (95%) can go at least 10 years without needing another surgery. Almost as many (90%) can go 20 years. Most people don’t need another mitral valve surgery after a successful repair.

What is the life expectancy after mitral valve repair?

Your life expectancy depends on many factors, including the severity of your mitral valve disease and your overall health. But researchers have found that people who get a repair at the right time have a life expectancy like others of their age and sex.

Mitral valve repair can help you live a longer and healthier life. Like all heart surgeries, it carries risks. Most people survive the surgery. But some people don’t.

The number of people who don’t survive an isolated mitral valve repair procedure is less than 1 in 1,000 at experienced centers.

If your provider recommends surgery to repair your mitral valve, they believe the benefits of the surgery outweigh the risks. It’s important to talk with your provider about your specific risks of having surgery and your chances of survival. Also, ask your provider what you may expect if you don’t have the surgery.

When should I call my healthcare provider?

Your provider will let you know how often you need to return for follow-ups. Be sure to keep all your follow-up appointments and tell your provider how you’re feeling. Everyone has some discomfort, and your provider will prescribe pain medication. But call your provider if you have signs of complications. These include:

• Chest pain
• Chills
• Coughing up blood
• Coughing up mucus that looks yellow or green
• Dizziness or fainting
• Fever
• Headache that’s very severe
• Irregular pulse (too slow or too fast)
• Nausea and vomiting
• Pain, redness or swelling in your lower leg
• Pain in the area of your incision that won’t go away
• Shortness of breath
• Signs of infection around your incision, like oozing or redness
• Slurred speech or other signs of a stroke

Your provider will tell you if there are other signs you should look out for. For instance, if you’re taking blood thinners, you should call your provider if you:

• Fall
• Have excessive bleeding in any area of your body (including your nose or gums)
• Have many bruises on your skin

It may be hard to know when a symptom is a normal part of recovery, or when it’s a sign of a complication. When in doubt, pick up the phone and call your care team. It’s better to get checked out and learn nothing’s wrong than to ignore a problem that needs medical care.

Can a surgeon perform mitral valve repair in the same surgery as another procedure?

Yes, a surgeon can perform more than one procedure in one surgery. Many people who have mitral valve disease also have atrial fibrillation (AFib). If you have AFib, your surgeon can perform the maze procedure to treat your AFib during the same operation.

What other kinds of mitral valve repair do surgeons perform?

Surgeons also perform the repair for an infection in your valve (endocarditis). Your surgeon will need to remove all infected tissue from your valve. If there’s enough healthy tissue left, your surgeon can reconstruct your valve. Otherwise, you may need a new valve (valve replacement).