Overview

Mitral valve repair and mitral valve replacement are types of heart surgery to fix or replace a leaky or narrowed mitral valve. The mitral valve is one of four heart valves that control blood flow in the heart. It sits between the upper and lower left heart chambers.

Doctors can do mitral valve repair and mitral valve replacement as open-heart surgery or surgery with smaller cuts, called minimally invasive surgery. The method used depends on whether your healthcare team decides you're a candidate for minimally invasive surgery.

Surgeons usually recommend mitral valve repair instead of replacement, when possible. It keeps the existing heart valve and can help save heart function.

Mayo Clinic's approach

Why it's done

Mitral valve repair or replacement is done to treat a damaged or diseased mitral valve. The mitral valve sits between the upper and lower left heart chambers. The valve has flaps, also called leaflets, that open and close to let blood pass through.

Your healthcare team may suggest mitral valve surgery if you have:

  • Mitral valve regurgitation. The valve flaps don't close tightly. This lets blood leak backward. If mitral valve regurgitation symptoms are severe, doctors usually recommend mitral valve repair surgery.
  • Mitral valve stenosis. The valve flaps become thick or stiff. Sometimes they stick together. The valve opening gets narrow so less blood can flow through the valve. Mitral valve surgery may be done if the narrowing, called stenosis, is severe and causes shortness of breath or other symptoms.

Sometimes, your healthcare team may recommend mitral valve surgery even if you don't have symptoms. For example, if you need heart surgery for another condition, surgeons might do mitral valve surgery at the same time. Research suggests that doing valve surgery in some people with severe mitral valve regurgitation who don't have symptoms improves long-term outcomes.

Mitral valve repair also may be done to avoid possible future complications that sometimes can happen with mitral valve replacement. Complications depend on the type of replacement valve used. Complications may include blood clots and failure of the replaced heart valve.

Risks

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

  • Bleeding.
  • Blood clots.
  • Failure of the replacement valve.
  • Irregular heartbeats, called arrhythmias.
  • Infection.
  • Stroke.

How you prepare

To prepare for mitral valve repair or replacement, you have tests to get more details about your heart. For example, you usually have an ultrasound of the heart, also called an echocardiogram.

Your care team tells you what to expect before, during and after surgery.

Talk to your loved ones about your surgery and hospital stay. Tell them what help you may need when you return home.

Food and medications

Before mitral valve surgery, talk to your care team about:

  • The medicines you take. Ask whether you can take them before your surgery.
  • Allergies or reactions you've had to medicines.
  • When you should stop eating or drinking before surgery.

Clothing and personal items

Your care team may recommend that you bring certain items to the hospital, including:

  • A list of your medicines.
  • Eyeglasses, hearing aids or dentures.
  • Personal care items, such as a brush, a comb, a shaving kit and a toothbrush.
  • Loose, comfortable clothing.
  • A copy of your advance directive. This is a legal document. It includes instructions about the kinds of treatments you want or don't want in case you become unable to express your wishes.
  • Items that help you relax, such as portable music players or books.

During mitral valve repair or replacement, do not wear:

  • Contact lenses.
  • Dentures.
  • Eyeglasses.
  • Jewelry.
  • Nail polish.

What you can expect

Surgery to repair or replace the mitral valve happens at a hospital. A heart surgeon, called a cardiovascular surgeon, performs the surgery.

If you also need heart surgery for another condition, the surgeon may do both surgeries at the same time.

Before

Before mitral valve surgery starts, a member of your care team may shave any body hair from your chest area. Your care team cleans your skin using a special soap that kills germs and helps prevent infection.

You get medicines to put you in a sleeplike state if you're having open-heart or minimally invasive surgery. This is called general anesthesia. You are connected to a heart-lung bypass machine, which keeps blood moving through the body during the surgery.

During

What happens during mitral valve repair and replacement depends on the specific method used. Doctors can do mitral valve surgery in different ways.

  • Open-heart surgery. The surgeon makes a cut, called an incision, through the middle of the chest to reach the heart.
  • Minimally invasive heart surgery. The surgeon uses much smaller cuts than in open-heart surgery. This approach may mean a shorter hospital stay, faster recovery and less pain than open-heart surgery. It's generally best to have minimally invasive heart valve surgery done at medical centers with doctors and teams experienced in doing these surgeries often.
  • Robot-assisted heart surgery. This is a type of minimally invasive surgery. A surgeon uses robotic arms to make precise movements during surgery.
  • Catheter-based procedure. Some heart valve repairs use a long, thin tube called a catheter. Through the catheter, a doctor can pass clips, plugs or other devices to repair or replace the mitral valve. Examples of catheter-based procedures are transcatheter mitral valve replacement (TMVR) and mitral valve clip, also called transcatheter edge-to-edge repair (TEER).

Mitral valve repair

Heart doctors recommend mitral valve repair when possible. During mitral valve repair surgery, a surgeon might:

  • Patch holes in the mitral valve.
  • Reconnect the valve flaps, called leaflets.
  • Remove extra tissue from the valve so that the flaps can close tightly.
  • Replace or remove pieces of tissue called cords that are diseased and no longer support the valve.
  • Separate valve flaps that are stuck together.
  • Tighten or reinforce the ring around the valve, called the annulus.

Types of mitral valve repair include:

  • Annuloplasty. Surgeons tighten or reinforce the ring around the valve. Annuloplasty may be done alone or with other methods to repair a heart valve.
  • Valvuloplasty. Also called balloon valvotomy, this treatment widens a narrowed mitral valve opening. The doctor inserts a long, thin tube called a catheter with a balloon on the tip into a blood vessel in the arm or groin and guides it to the mitral valve. The balloon is inflated. This makes the mitral valve opening larger. The doctor then deflates the balloon and removes the catheter and balloon.
  • Mitral valve clip. A doctor guides a catheter with a clip on its end from a blood vessel in the groin to the mitral valve. The clip is used to fix a torn or leaky mitral valve flap, called a leaflet. Your healthcare team may recommend this treatment if you have severe mitral valve regurgitation and you cannot have other types of mitral valve surgery. Mitral valve clip also is called transcatheter edge-to-edge repair (TEER).

Mitral valve replacement

During mitral valve replacement, the heart surgeon removes the mitral valve and replaces it with a new one. The new valve may be a mechanical valve or a valve made from cow, pig or human heart tissue. This is called a biological tissue valve.

Sometimes, if a biological tissue valve no longer works well, the doctor can place a new valve inside it using a thin, flexible tube called a catheter. This is called a valve-in-valve procedure, also called a transcatheter mitral valve-in-valve procedure.

After

After mitral valve repair or replacement surgery, you usually spend a few days in the hospital. How long you stay in the hospital depends on your specific condition and surgery.

During your hospital stay, your care team often checks your blood pressure, breathing and heart rate. You may get:

  • Fluids and medicines through an IV.
  • Oxygen.
  • Pain medicine.

You might have tubes to drain urine from your bladder and fluid and blood from your chest.

In the hospital, your care team helps you:

  • Slowly build up your activity level.
  • Take longer and longer walks in the hospital.
  • Do breathing exercises.

Your care team gives you instructions to follow during recovery, such as:

  • How to care for your surgical cuts, called incisions.
  • What medicines to take and when.
  • How to manage pain and other side effects.
  • Signs of infection and when to call your care team.

After mitral valve repair or mitral valve replacement, your healthcare professional tells you when it's safe to return to daily activities, such as working, driving and exercise.

Results

Mitral valve repair and replacement surgery may help ease valve disease symptoms. The treatment also may improve your quality of life.

If you had mitral valve replacement with a mechanical valve, you need to take blood thinners for life to prevent blood clots. Biological tissue valves break down over time and usually need to be replaced. Mechanical valves usually do not wear out over time.

You'll need regular health checkups to make sure your repaired or replaced valve is working well. Your healthcare professional may recommend a program of education and exercise to help you improve your health and recover after heart valve surgery. This program is called cardiac rehabilitation, often called cardiac rehab.

Following a healthy lifestyle is important to heart health before and after mitral valve repair or mitral valve replacement. A healthy lifestyle can include the following:

  • Don't smoke or use tobacco.
  • Get regular exercise.
  • Keep a healthy weight.
  • Eat nutritious foods and limit salt and saturated fats.
  • Manage stress.
  • Manage blood pressure, cholesterol and blood sugar.
  • Get 7 to 8 hours of sleep each day.
By Mayo Clinic Staff