Mitral Valve Repair and Replacement

Mitral valve repair can help patients see significant improvement. It is the only heart operation in which your life expectancy afterward is identical to someone with no heart disease.

Choose UMMC for Mitral Valve Repair

Receiving care from a top valve program with skilled and experienced doctors increases your chances of keeping your own valve and achieving a successful outcome. While many centers simply replace problematic mitral valves, at the University of Maryland we have taken a different approach that allows the bulk of our patients to keep their valves.

With our Heart Valve Program, you can expect:

• Proven Results: Our repair rates for degenerative mitral valve disease are in excess of 95 percent, while the national average is 60 percent to 70 percent.
• Teamwork: Heart center specialists covering all aspects of mitral valve care meet weekly to discuss who may benefit from surgery and who will likely not. This helps us make the best recommendation.
• Treatment choices: We offer minimally-invasive surgical repair that leave behind smaller incisions. For patients who cannot undergo traditional surgery, we offer catheter-based repairs (learn more about transcatheter mitral valve repair.) When repairs are not possible, we can replace the valve with the latest artificial valve.

UMMC is also the first hospital in Maryland to offer robotic heart surgery for patients with advanced mitral valve disease, which is a less invasive procedure than traditional heart surgery.

Mitral Valve Repair Benefits

Mitral valve repair is the preferred surgical treatment for mitral valve disease instead of replacement. Mitral valve repair has a high success rate; approximately 90 percent of repaired valves are still working 20 years later, with just 10 percent of patients needing a second operation during that time.

Mitral valve repair offers a number of benefits, including:

• Higher survival rates
• No long-term use of blood thinners (required if you get a mechanical replacement valve)
• Safer — lower risk of mortality, infection and stroke

Minimally Invasive Mitral Valve Repair

We lead the way in minimally invasive mitral valve repair. We performed Maryland's first catheter-based repair, and we also completed the mid-Atlantic's first surgical repair using a minimally invasive approach.

We offer two types of minimally invasive mitral valve repair:

• For patients who cannot undergo an operation: We offer catheter-based repair for patients with leaky valves (regurgitation), as an approved treatment or through a clinical trial. That means we do not have to open the chest or use a heart-lung machine. We can also open some narrowed mitral valves with a catheter and a balloon (learn more about valvuloplasty.)
• For patients who prefer a smaller incision: Some of our patients who are eligible for surgery prefer smaller incisions, made on the side of the chest. While the standard approach is very successful, we try to honor this request when possible. But sometimes we cannot, since we need to prioritize your health and valve function. This type of minimally invasive surgery still requires a heart-lung machine, which temporarily takes over for the heart and lungs.

Some examples of our surgical repair include:

• Sewing in a new ring of plastic, cloth or tissue to support the valve's circular frame (the annulus)
• Trimming off the diseased portion of a valve flap (leaflet) and closing up the defect
• Reconstructing leaflets, then using sutures to support the valve
• Replacing a leaflet using tissue surrounding the heart (the pericardium)

Complex Mitral Valve Repair

Our mitral valve expertise extends to repairs of complex cases. These can include:

• Patients who previously underwent surgery for another heart-related problem like a blocked artery and subsequently need a mitral valve repair
• A repaired valve developing a new leak due to a cause like infection
• Valves that were not properly repaired at another center

These cases require skilled surgeons because the valve is often surrounded by scar tissue that naturally develops as the body heals from previous operations. Follow-up operations are also challenging when patients are elderly, in poor health for other reasons or have poor heart function.

Mitral Valve Replacement

Sometimes your mitral valve cannot be repaired and will need a replacement. There are two different options in this case:

• Mechanical replacement: This uses a metal valve that lasts a lifetime but you would need to be on a certain blood thinner (warfarin) for the rest of your life. This medication requires frequent blood draws and monitoring to make sure your blood is not too thin or too thick.
• Bioprosthetic valve or tissue valve: These valves are either bovine (cow) or porcine (pig). They do not require lifelong blood thinners. The disadvantage to these valves is that they gradually wear out over time. They last an average of 10-15 years in the mitral position. You will need close follow-up with your cardiologist. When the valve no longer functions as it should, your cardiologist may refer you back to the surgeon to consider a re-operation of your mitral valve.