Is surgery the only option for fixing a leaky heart valve?

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There are different types of leaky heart valves. Currently, medical professionals in the United States can manage one type of leaky heart valve — mitral regurgitation — without open heart surgery. In addition, the Food and Drug Administration (FDA) has only approved one noninvasive procedure to treat leaky heart valves. This procedure is called the MitraClip. Several clinical trials are examining other options.

However, while an off-label option, a doctor can treat aortic regurgitation with a transcatheter aortic valve replacement (TAVR). It is also possible to treat a tricuspid regurgitation with a tricuspid clip. However, it does not currently have approval in the U.S.

Depending on which valve is causing the issue — the mitral, aortic, pulmonary, or tricuspid valve — several factors may be behind a leaky heart valve. Not all of these are fixable without invasive surgery.

Learn more about the types of leaky heart valves.

The most common type of leaky valve is mitral regurgitation, and a mitral clip — the MitraClip — is the only FDA-approved noninvasive valve repair treatment that treats this type of leaky valve.

This is a transcatheter edge-to-edge repair device that clips together faulty leaflets, reducing valve leakage. A cardiologist puts these in place using a catheter — a tube through which they insert the mitral clip. The cardiologist threads the catheter to the heart through blood vessels, typically a large blood vessel from the groin.

An individual with a leaky mitral valve would be eligible for a mitral clip procedure on meeting the following criteria:

• They have severe mitral regurgitation.
• They have heart failure that is causing severe symptoms.
• They are not suitable candidates for invasive surgery.
• Their presentation of a leaky heart valve is fixable.
• The referring doctor anticipates a good life expectancy after the procedure.

For some people, heart surgery presents too high a risk. This edge-to-edge device can provide an alternative option for correcting their leaky heart valve.

The risks of this procedure include:

• hemorrhage
• arrhythmias
• blood clots
• aneurysms

However, a 5-year randomized controlled trial suggests superior safety outcomes compared with surgery.

The trial indicates that edge-to-edge repair reduced the need for follow-up surgery by around the same extent as more intensive surgical treatments, even though more people experienced mitral regurgitation in the year following mitral clip treatment than with surgery.

A clinical trial has been underway since 2014 to measure the safety and effectiveness of the AccuCinch System. This option is for treating secondary mitral regurgitation. This refers to regurgitation that occurs due to issues with the left ventricle or left atrium, and is not a primary issue with the valve itself.

A cardiologist implants this device through a catheter, but instead of the leaflet, the implant attaches to the wall of the ventricle. This aims to reduce strain on the wall of the ventricle, make the ventricle smaller, and make the heart wall stronger without intensive surgery.

While not yet fully approved, the FDA assigned Breakthrough Device status to the AccuCinch System in 2022. Breakthrough Device designation means that the development, assessment, and review of this device may move quicker, and that another noninvasive option could soon become available for people with leaky heart valves.

Also known as transcatheter aortic valve implantation (TAVI), this is a minimally invasive procedure that involves inserting a new valve. A surgeon has two options to implant the valve. A transfemoral approach uses a large artery in the groin, while a transapical approach involves a small incision in the chest.

A 2021 systematic review indicates that TAVR can be a safe and effective option for treating aortic regurgitation. However, a 2021 study highlights that further studies are still necessary to evaluate this option.

Transcatheter tricuspid valve intervention (TTVI) may be an alternative to medical therapy and surgery. Similar to treating mitral regurgitation with a mitral clip, an edge-to-edge device may also be an option for treating tricuspid regurgitation.

A 2022 literature review suggests that TTVI can be a feasible, safe, and effective treatment option for reducing tricuspid regurgitation.

Many people with a leaky heart valve may experience mild-to-moderate symptoms that do not yet warrant valve repair or replacement. For these people, some medications can help to:

• relieve symptoms
• manage other heart issues that may be worsening the leaky heart valve
• stop the leaky heart valve from becoming more severe

These medications might include:

• diuretics and vasodilators to reduce high blood pressure and strain on the heart
• drugs that help manage a person’s heart rate
• blood thinners to reduce a person’s risk of blood clots
• antibiotics to manage infections that inflame the heart

Clinical trials into noninvasive methods of treating leaky heart valves are ongoing. At present, only one method — a mitral clip — has FDA approval. Researchers are investigating other methods, some of which are on a fast track to development and safety review but are not yet available.

Depending on the specific type of heart valve regurgitation, there may be less invasive options than surgery to help manage the condition. As such, it is advisable for people to consult with a cardiologist about medications and other less invasive procedures that may be effective.