If your chronicmitral valve regurgitation (MR) becomes severe or you develop symptoms of heart failure, such as shortness of breath, swelling, and fatigue, surgery to repair or replace your mitral valve will be necessary. Regardless of symptoms, surgery is recommended when your ejection fraction drops below 60% and/or your left ventricle is larger than 40 mm at rest.¹

Having surgery on your valve before symptoms occur may help you avoid heart damage that is beyond repair. Some doctors believe it's best to repair or replace the valve before you develop severe symptoms because people who have severe symptoms don't recover as well as people who do not.

The decision between repairing or replacing the valve depends on the type of damage you have. For instance, repair is more successful if there is limited damage to certain areas of the mitral valve flaps (leaflets) or to the chordae tendineae, the tough fibers that control movement of the mitral valve leaflets. But replacement is usually preferred for people who have a hard, calcified mitral valve ring (annulus) or widespread damage to the valve and surrounding tissue.

Repair is preferred over replacement because research shows that:²

• Repair leads to better long-term survival.
• Long-term anticoagulants are not needed after repair.
• There is better function of the left ventricle following repair.
• There is less risk of serious bleeding after repair.

Repair may be done by reshaping the valve or removing excess tissue, adding support to the valve ring, or attaching the valve to other cordlike tissues in the heart (chordal transposition).

With replacement, the badly damaged valve is removed and a mechanical (plastic or metal) or bioprosthetic valve (usually made from pig tissue) is sewn into place. If you receive a mechanical valve, you are more likely to develop blood clots in the heart than if you received a bioprosthetic valve, so you will need anticoagulant medicine for the rest of your life to prevent clots from forming and possibly causing a stroke.

Surgery is usually delayed if no symptoms or signs of heart failure are present. People with severe MR, no physical symptoms, and whose left ventricle is functioning normally may be monitored every 6 to 12 months by their doctor. If follow-up testing shows enlargement or abnormal function of the left ventricle, surgery is then usually advised.

With acute MR, urgent surgery to repair or replace the valve is usually necessary. In some cases, surgery to correct the cause of acute MR may also be needed.