The mitral valve is inside a person’s heart. A person with mitral valve disease may require mitral valve repair surgery as a treatment.

A person’s heart contains four chambers. The two upper chambers are the right atrium and the left atrium. The lower chambers are the right ventricle and the left ventricle.

The mitral valve allows blood to flow from the left atrium into the left ventricle. As a person’s heart beats, this valve opens and closes, preventing blood from flowing back into the left atrium.

Mitral valve disease is a collection of conditions that can damage the mitral valve. Mitral valve repair is a surgical procedure that can help treat certain types of mitral valve disease.

Read on to learn more about mitral valve repair surgery, including how it works and its possible risks.

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Surgeons can use mitral valve repair surgery to treat mitral valve disease. A 2022 article commenting on older research notes that up to 2–3% of people in the United States have degenerative mitral valve disease.

Mitral valve surgery may involve repairing or replacing the valve, with repair often preferable but not always an option.

Mitral valve repair surgery is a treatment option for people who have symptoms due to their condition. However, surgeons may use it to treat people without symptoms in certain cases.

Types of mitral valve disease

There are two main types of mitral valve disease:

Valve regurgitation

Mitral valve regurgitation is a type of mitral valve disease that occurs when the valve does not close properly. This allows blood to leak back into the left atrium. In severe cases, it can cause a person to develop heart failure.

Mitral valve prolapse is a subtype of valve disease that can lead to regurgitation. It occurs when the valve becomes weakened, allowing it to balloon up into the left atrium during a heartbeat. The American Heart Association (AHA) notes that this is generally harmless. However, in addition to mitral valve regurgitation, it can also lead to arrhythmias.

Valve stenosis

Mitral valve stenosis is the other main type of mitral valve disease. It refers to a narrowing of the valve opening. This can cause a reduction in blood flow through the valve, which can lead to a buildup of pressure that can cause pulmonary hypertension and arrhythmias.

There are several types of mitral valve repair surgery. Each type can treat different issues with the mitral valve.

The three main types of mitral valve repair surgery include:

  • Annuloplasty: This involves a surgeon sewing a synthetic ring around a person’s mitral valve to help strengthen and tighten the valve. Most mitral valve repair surgeries involve an annuloplasty. A surgeon can perform it as a stand-alone procedure or alongside other forms of mitral valve repair.
  • Leaflet resection: A surgeon removes the damaged section of a person’s mitral valve. The two sides of the valve are known as leaflets. The surgeon cuts out a triangular or rectangular section of the damaged area, then sews the open sides together.
  • Chordal repair: This involves a surgeon replacing damaged chordae, which are thick, fibrous cords that connect the mitral valve leaflets to the heart muscle. If several chordae become weakened, a person can develop a prolapse. A surgeon may replace these damaged chordae with synthetic ones.

Another form of mitral valve surgery is minimally invasive mitral valve surgery (MIMVS). MIMVS involves a surgeon using keyhole surgery to operate on a person’s heart.

The procedure for a mitral valve repair may vary depending on the type of surgery.

Doctors will choose the best surgery option for a person depending on:

  • the type of mitral valve disease they have
  • other health conditions they have
  • whether they can have open-heart surgery
  • their age

Steps

A mitral valve repair surgery may involve the following steps:

  1. An anesthesiologist uses medication to put the person to sleep.
  2. The surgeon attaches a cardiopulmonary bypass machine to the person. This machine takes over heart and lung function during the operation, allowing the surgeon to work on a person’s heart while it is not beating.
  3. The surgeon makes a cut in a person’s chest. Where they cut can depend on the kind of surgery a person has. The cut may occur:
    • down the center of the chest
    • part of the way down the chest
    • between two ribs
  4. The surgeon clamps the person’s aorta to prevent blood from flowing into the heart.
  5. They cut open the heart to access the mitral valve.
  6. The surgeon may perform different forms of repair depending on the type of mitral valve disease a person has. This may include an annuloplasty, leaflet resection, or chordal repair.
  7. The surgeon checks to ensure the valve is functioning, then takes the person off the cardiopulmonary bypass machine.
  8. They close the incision.

Surgeons generally prefer to repair a mitral valve rather than replace it.

Valve repair has certain advantages over replacement, such as avoiding the following:

  • long-term blood clotting
  • a faulty prosthetic valve
  • possible leaks between the replacement valve and the original valve

It also has lower surgical risks and better long-term outcomes.

However, certain people may require a mitral valve replacement due to specific valve issues that prevent a mitral valve repair.

A person may have a mitral valve replacement if they had ineffective mitral valve repair surgery.

Data from 2018 note that, in centers with surgeons who are experts in mitral valve repair surgery, success rates may be over 90% or close to 100%.

Research from 2020 found that MIMVS was successful in 95.8% of cases.

A 2022 article commenting on older research states that if a person has a mitral valve repair early enough, they have a life expectancy similar to someone the same age who does not have mitral valve disease.

According to data from 2018, mitral valve surgery is generally low risk, with a mortality rate of 1–2%.

Complications that a person may experience can include:

A doctor will speak to a person about what to expect during recovery from mitral valve repair surgery.

The AHA states that a person usually recovers from heart valve surgery in 4–8 weeks. Recovery time may be shorter for people who have MIMVS or percutaneous mitral valve repair.

A doctor may encourage a person to do certain activities as soon as they can after their surgery. This can include:

  • getting up
  • walking
  • eating
  • drinking
  • breathing deeply

A person may have to avoid strenuous activities after their mitral valve repair. This may include heavy lifting or intense exercise.

Mitral valve repair surgery is a surgical procedure to treat mitral valve disease. There are various forms of mitral valve surgery. Each form can help treat a specific issue with a person’s mitral valve.

Mitral valve repair surgery has certain advantages to mitral valve replacement surgery, such as fewer risks and better long-term outcomes.

With a surgeon who is an expert at mitral valve repair, outcomes are often very favorable.