Mitral Valve Replacement or Repair? The Differences

What is mitral regurgitation?

Mitral regurgitation is a condition where the mitral valve doesn't close completely. When the left ventricle contracts, it pumps blood through the aortic valve to the body. However, some blood may leak back into the left atrium and then the lungs. Causes include misaligned valve leaflets, annulus dilation, lengthening or rupture of the chordae tendineae, papillary muscles, or left ventricular dilation.

Mild mitral regurgitation may not require surgery, but regular check-ups are vital. Moderate or severe regurgitation usually needs valve repair or replacement. Other factors are considered to determine if intervention is necessary for moderate mitral regurgitation. A diseased valve is more prone to infection, potentially leading to bacterial endocarditis.

 

What are mitral valve repair and replacement?

Cardiac surgery to repair valvular defects

Surgery before significant mitral valve degeneration prevents irreversible heart damage. Medication can sometimes alleviate symptoms, though temporarily.

Surgery is considered when echocardiography shows severe insufficiency and the patient experiences symptoms. Even with unclear symptoms, the overworked left ventricle's condition must be assessed, as serious, irreversible dysfunction is a risk.

 

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When is mitral valve replacement discussed?

Severe valve damage often necessitates replacement; otherwise, repair may suffice. Native valve repair is mainly for mitral regurgitation. Most repairs address degenerative disease causing valve component rupture or elongation. Replacing broken or elongated segments with synthetic cords removes defective parts and shortens overly long ones.

For mitral stenosis, mitral valve replacement (with a bioprosthesis or mechanical prosthesis) is often preferred. Mitral valvuloplasty may be considered, but is limited by severe rheumatic damage making leaflets thick and rigid, hindering repair.

Significant rheumatic damage necessitates replacement with an artificial valve prosthesis when repair is insufficient. Two types exist: mechanical (metal/pyrolytic carbon) and tissue (animal tissue). Choosing the appropriate valve is crucial for recovery.

Mitral valve repair or replacement is typically performed by a cardiologist.

How are mitral valve replacement and repair procedures performed?

Mitral valve repair

Mitral valve repair uses various techniques (sternotomy or mini-thoracotomy) depending on age, lesion, health, and other conditions. The heart is stopped, and a heart-lung machine maintains circulation. Post-reconstruction, an echocardiogram confirms proper heart function. The procedure is personalized for optimal results.

 

Mitral valve replacement

If repair is impossible, a mechanical or biological prosthesis is used. Mechanical prostheses are durable but require anticoagulants. Biological prostheses (animal tissue) don't, but have a shorter lifespan. Choice depends on life expectancy, anticoagulant suitability, lifestyle, and patient preference.

 

What are the risks of mitral valve repair or replacement?

Mitral valve surgery risks include bleeding, infection, neurological issues, heart failure, and heart attack. Less serious side effects: inflammation, lung fluid, palpitations, pain, appetite loss, and fever. For elderly patients or those with other illnesses, less invasive catheter therapies may be preferable.

Mortality is generally below 3%, but risk assessment considers age, health, and pre-existing conditions.

Functional recovery is successful in 96% of cases. However, avoiding premature surgery prevents left ventricle dysfunction from untreated mitral pathology.

 

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