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Mitral Valve Regurgitation: 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 usually is the preferred surgery instead of replacement of the valve.

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 is typically preferred over replacement. Repair for mitral valve regurgitation:1

  • May lead to better long-term survival.
  • Does not need long-term anticoagulants after surgery.
  • Leads to better function of the left ventricle.
  • Has less risk of serious bleeding.

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 a mitral valve replacement, the better the results of the procedure.
  • It prevents the need for lifelong blood-thinning therapy (anticoagulation), which is required to prevent the clotting that typically occurs when an artificial valve is put in the heart.
  • It reduces the need for repeat valve surgery later in life.
  • It may lead to fewer complications and better results after surgery than with mitral valve replacement.

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:

  • An artificial valve will 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.

References

Citations

  1. Bonow RO, et al. (2008). 2008 Focused update incorporated into the ACC/AHA 2006 Guidelines for the management of patients with valvular heart disease: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing committee to revise the 1998 Guidelines for the management of patients with valvular heart disease). Circulation, 118(15): e523–e661.

Credits

By Healthwise Staff
Primary Medical Reviewer Rakesh K. Pai, MD, FACC - Cardiology, Electrophysiology
Specialist Medical Reviewer John A. McPherson, MD, FACC, FSCAI - Cardiology
Last Revised November 29, 2011

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