How does mitral valve repair compare with mitral valve replacement?

The great majority of patients with mitral regurgitation due to prolapse should have a repair not a replacement, as valve replacement carries a worse long-term survival and complication rate than repair.

Both options involve open-heart surgery through either a 3-4 inch incision through the breast bone, or between the ribs. Mitral valve repair is technically more complex than replacement and may take a little longer. Mitral valve repair is the most effective treatment for mitral valve regurgitation. It is the only treatment shown to restore life-expectancy to normal. Your surgeon will restore the structure supporting the valve leaflets to its normal size and shape usually using a manufactured ring, and use a variety of techniques to reconstruct the valve, making sure enough leaflet meets in the middle of the valve to make it watertight again.

The great majority of patients with mitral regurgitation due to prolapse should have a repair not a replacement, as valve replacement carries a worse long-term survival and complication rate than repair. The risks of stroke, reoperation and valve infection, as well as the risk of dying are all higher after mitral replacement compared to successful repair. Additionally people who have mechanical valves must take Coumadin for life, which can cause bleeding and must be monitored with regular blood tests.

Disorders of the mitral valve can be treated surgically by either a mitral valve repair or a mitral valve replacement.  The abnormal valve may be narrowed, leaking, or both.  The decision whether to repair or replace the valve is made by the surgeon based on what is wrong with the valve.  A repair is preferred if possible, since it preserves the normal valve mechanism and can have the benefit of improved heart function after surgery.  Also, some artificial heart valves used in replacement require lifelong anticoagulation with a blood thinner.  So a repair would potentially eliminate this need and the associated risk. The repair is performed on the valve leaflets, which are the two thin pieces of tissue which move apart like two trap doors to open and close.  The surgeon makes incisions in narrowed valves to increase their area, or, more commonly, small sections of redundant or floppy valves are removed.  Small cords of tissue, called chordae, support the valve from beneath and keep the leaflets from prolapsing backwards.  These are like the ropes on a parachute, without which the parachute, or part of it, would turn inside out.  Sometimes the surgeon must replace or adjust these cords as part of the mitral valve repair.  On nearly all repairs, the surgeon will sew an artificial ring around the periphery of the valve.  This supports the valve and narrows the periphery, preventing the valve from leaking.  If the repair is not possible, and certainly if the surgeon thinks that the repair will not have a satisfactory result, then the valve is replaced.  In a replacement, some but not all of the valve leaflets are removed, preserving as much of the underlying cord mechanism as possible.  The artificial valve is then sewn in.  A mechanical valve, which has no natural tissue, may be chosen.  The other choice is a tissue valve, usually made of porcine (pig) or bovine (cow) natural tissue.  If you are being considered for valve replacement, your surgeon will talk to you regarding which valve is the best for you.