Mitral valve repair refers to several types of surgical corrections of the heart’s mitral valve. This valve is on the left side of the heart and lies between the left atrium and left ventricle. When functioning well, it opens to allow passage of blood from the atrium to the ventricle, and then closes shut so blood doesn’t leak backward. Sometimes the valve doesn’t close properly and people suffer from insufficiency or regurgitation, where blood can move back into the atrium, and other times the valve gets narrowed (stenotic) and may not allow enough blood to pass into the left ventricle. These conditions and others may call for mitral valve repair.
It is important to distinguish between mitral valve repair and replacement. In replacement, the malfunctioning valve is removed and a new one that is mechanical or biological is put in its place. Extremely serious damage of the mitral valve, as is occasionally present at birth or develops later, may necessitate replacement. During a repair, cardiothoracic surgeons work with the existing valve, attempting to correct any problems that are interfering with function.
Each mitral valve repair may be different depending on where the damage lies. When stenosis is present, sometimes the goal may be to simply open the valve, and this may be a closed surgical procedure performed by cardiologists in a catheterization lab. Using catheterization, a doctor can inflate a balloon in the narrowed area to open the valve so it will work properly. Sometimes a stent is placed to keep the area open.
Most other kinds of mitral valve repair are open-heart surgeries. Some surgical centers specialize in minimally invasive surgeries, which mean incisions are smaller, and cracking the chest or breaking the sternum are not necessary. Each surgeon has a preference on how they approach surgery and when they feel an certain approach is warranted.
Some of the common things done during mitral valve repair include repairing the leaflets that open or close if they are malformed or thickened. A section of the valve that is working improperly may be removed and the rest sewn down to create a better opening and closure. Sometimes the chordae, which attach to the leaflets get damaged and they can’t communicate with the valves to work as normal. Chordae could be repaired, or removed and replaced with gore-tex material. Surgeons may also employ some devices such as rings that they sew into the valve to stabilize it.
Mitral valve repair is typically preferred to mitral valve replacement, and people getting this surgery at a well-respected heart center have a high survival rate. Not all problems with the mitral valve are repairable, and though surgeons might prefer repair to replacement, it isn’t always the best choice. People might get second or third opinions if they face a replacement and want a repair instead. It is possible that all doctors consulted will agree that a mitral valve repair is not appropriate in some circumstances.