Mitral Valve Insufficiency: Repair or Replacement?

Mitral valve insufficiency is one of the valve diseases we treat most often in our clinic; the most fundamental question we face when deciding on treatment is whether the valve can be repaired. In this article I will explain the difference between repair and replacement of the mitral valve and why we give priority to repair.

Why Does the Mitral Valve Leak?

The most common cause of mitral valve insufficiency is the loosening, lengthening or rupture over time of the fine cords (chordae) that attach the valve to the heart, or of the valve leaflets themselves (degenerative/myxomatous disease); in this case the valve leaflets cannot close completely and blood leaks backwards. Less frequently, functional insufficiency due to enlargement of the heart itself, or a past infection (endocarditis), are also among the causes.

Why Is Repair the Preferred Option?

Whenever possible, we always regard repairing the valve rather than replacing it as our priority; because we preserve the patient’s own tissue, the need to take blood thinners for life is removed, the risk of valve infection is lower, and long-term cardiac function generally follows a better course. The great majority of degenerative mitral insufficiency can be repaired with a high success rate in experienced centres.

Valves That Cannot Be Repaired and the Replacement Process

If the valve tissue is excessively damaged, calcified, or has been destroyed as a result of a severe past infection, repair may not be durable; in this case we replace the valve with an artificial one (mechanical or biological). During the operation we first attempt repair and confirm with echocardiography that the leakage has been corrected sufficiently; if an adequate result cannot be obtained, we proceed to replacement in the same session.

Frequently Asked Questions

Is repair possible in every case of mitral insufficiency? No; the degree and cause of damage to the valve determine this decision, but in most degenerative disease repair can be carried out successfully.

Is repair permanent? The long-term durability of repairs performed in experienced centres is quite high; rarely, reassessment may be needed years later.

Which is safer, repair or replacement? In general, repair is advantageous over replacement both in terms of surgical risk and long-term outcomes; for this reason we prefer repair whenever possible.

Conclusion

In mitral valve insufficiency, repair is always our first choice whenever it is possible; when the degree of damage to the valve does not allow this, we proceed safely to replacement. The decision takes shape during the operation according to the actual condition of the valve.

You can make an appointment for a detailed echocardiogram and examination so that we can assess the possibility of repair for your mitral valve insufficiency.

References

1. Otto CM, Nishimura RA, Bonow RO, et al. 2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease. Circulation. 2021;143(5):e72-e227.
2. Vahanian A, Beyersdorf F, Praz F, et al. 2021 ESC/EACTS Guidelines for the Management of Valvular Heart Disease. Eur Heart J. 2022;43(7):561-632.