Should I repair or replace my mitral valve?

There are two types of surgical procedures used to correct mitral valve regurgitation (MR): mitral valve repair and mitral valve replacement. Both of these are open-heart procedures.

In mitral valve repair the surgeon reconstructs the natural valve. In mitral valve replacement the surgeon removes the valve and replaces it with a prosthetic valve.

Factors that affect the choice between valve repair and valve replacement include:

• The surgeon's skill and experience in performing valve reconstructions, since repair surgery demands more technical precision than replacement surgery.
• The cause of the MR.

More specifically, the valve may be repaired easily if one of its anchoring structures (chordae tendineae) is ruptured or if one of its leaflets has degenerated mildly over time. On the other hand, if rheumatic fever, reduced blood flow to the valve area, or a hardening (calcification) of the valve has caused mitral regurgitation, the valve should probably be replaced, as these conditions damage the inherent shape and structure of the mitral valve beyond repair.

Mitral valve repair is generally preferred if your valve is suitable for reconstruction and the surgeon has the appropriate level of experience and surgical skill. The advantages of mitral valve repair include the following:

• Preserves your natural valve and its support (chordae tendineae). In general, the more of the natural valve that can be preserved during a mitral valve replacement, the better the results of the procedure.
• Prevents the need for lifelong blood-thinning medical therapy (anticoagulation), which is required to prevent the clotting that typically occurs when an artificial valve is introduced to the heart
• Reduces the need for repeat valve surgery later in life
• Leads to fewer complications and better postoperative results than mitral valve replacement

The disadvantages of mitral valve replacement include the following:

• A biological prosthetic valve will deteriorate over time.
• A mechanical prosthetic valve will likely cause blood clots and the resulting need for anticlotting (anticoagulation) therapies.

If you choose mitral valve replacement, it is best to preserve as much of the valve as possible: doing so provides a greater chance of postoperative success. Keeping the valve's base intact reduces the amount of foreign structures to which the heart must grow accustomed after replacement surgery.

Mitral valve replacement-in which the entire valve apparatus is destroyed-is a last-resort option, and it should be performed only when the original valve and associated structures are so distorted by physical abnormalities that none of the valve can be salvaged.