Repair or Replace: What’s The Best Way To Treat Mitral Valve Disease?

In life, it’s important to go with the flow. But when it comes to your heart, sometimes the flow needs a little bit of help.

Normally, oxygen-rich blood flows from your lungs into your heart, where it enters a chamber called the left atrium. Then, it flows into a pumping chamber called the left ventricle. From there, it’s supposed to go out and suffuse the rest of the body with refreshing oxygen.

But there’s a hurdle it has to clear first. Between the left atrium and ventricle is your mitral valve, which keeps blood flowing forward. However, if you have mitral valve disease, your blood flow is disrupted, and can even flow backward..


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Types of valve problems

There are three basic types of valve problems: atresia, stenosis and regurgitation.

Atresia is a rare congenital defect (present from birth).The mitral valve doesn’t form correctly, which prevents blood from flowing into the left ventricle properly. Infants who are diagnosed with mitral valve atresia are often treated with staged surgeries.

Stenosis occurs when the flaps (leaflets) of the valve stiffen, thicken or fuse together. This prevents your mitral valve from fully opening, meaning you do not get enough blood flowing through your valve. This is usually related to rheumatic heart disease but can also be related to age, radiation, and other diseases.

Mitral regurgitation one of the most common types of heart valve disorders, and it happens when your mitral valve doesn’t close tightly. Instead of only flowing forward into the left ventricle, blood also flows backward into your left atrium. There are a number of causes: age, rheumatic heart disease, infection, trauma, congenital defects, coronary heart disease, and a dilated heart. Mitral regurgitation is often associated with prolapse, when one or both of the flaps in your valve billow or are displaced.

If mitral valve disease is causing severe symptoms, your physician might recommend surgery to either repair or replace the dysfunctional valve.

To repair

When possible, physicians try to repair valves before replacing them, preserving your own heart tissue. And in comparison to replacements, repairs have several benefits:

  • They preserve the function and strength of your heart muscle.
  • They lower your risk of post-surgery infective endocarditis—an infection of the membrane that lines your heart’s valves and chambers.
  • You won’t need to take blood-thinning medication for the rest of your life.

Balloon valvuloplasty

A common form of valve repair for stenosis (narrowing) is called balloon valvuloplasty. It is minimally invasive, meaning there is less pain and blood loss, and a lower risk of infection than general surgery would present.Balloon Valvuloplasty process

Surgical options

Balloon valvuloplasty isn’t always an option, particularly if you have regurgitation (leaky valve).

To treat mitral valve regurgitation, your surgeon might shape, rebuild, or trim the flaps that open and close the valve or fix the chords that attach them to the heart. The surgeon might also sew a ring of cloth, tissue or metal around the valve to tighten it and stop blood from leaking backwards. Mitral valve repair is performed through several different approaches: open chest, through a small incision on the right side of the chest, or minimally invasively through small incisions on the right side of the chest, which can be robotically assisted.

Another less invasive treatment for mitral regurgitation is a MitraClip. It is a small clip that is attached to your mitral valve flaps, allowing your valve to close more completely.


You might also be interested in: What You Need to Know About Robotic Heart Surgery

To replace

There are also times when a mitral valve is too damaged to repair, meaning you will need to get a valve replacement. There are two main types of replacements: manufactured mechanical valves and biological valves.

Manufactured mechanical valves

Manufactured mechanical valves are made of durable, man-made materials like carbon and titanium. They are the longest-lasting type of replacement—most can last throughout your entire lifetime.

But, there’s a catch: You will most likely need to take blood-thinning medications for the rest of your life because of the risk of blood clots, which can get stuck in the valve flaps or hinges. Clots also can travel through your bloodstream and cause a heart attack or stroke.

Biological valves

Biological valves (also known as "tissue" or "bioprosthetic" valves) are made of valves and tissue from animal donors. They aren’t quite as long-lasting as mechanical ones—most can last about 10 to 20 years—and will eventually need to be replaced.

However, they have one clear advantage: They are less likely to cause clots. You might still need blood thinners right after surgery, but you won’t need to be on them long-term. Since there are bleeding risks associated with blood thinners, especially as you age—with or without valve replacement—most physicians recommend biological valves for people over age 65.

As with any medical decision, it’s important to get all the facts and review with your physician which option might be right for you. If you have mitral valve issues and would like a consultation, the Penn Heart Valve Disease Program is here to help.

About this Blog

The Penn Heart and Vascular blog provides the latest information on heart disease prevention, nutrition and breakthroughs in cardiovascular care.


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