Heart valve repair or replacement for mitral valve regurgitation or prolapse

Surgery is required for severe mitral valve regurgitation (MR).

Surgery for MR is recommended when you have symptoms of heart failure, or when your ejection fraction drops below 60% and/or your left ventricle is larger than 40 mm at rest.¹

In general, surgery for mitral valve prolapse (MVP) is only done if you have mitral valve regurgitation. Valve repair or replacement are the two types of surgery available to treat these conditions.

Both valve repair and replacement are typically open-heart surgeries. Minimally invasive types of surgery may be another option. This section describes open-heart surgery.

During valve surgery, you are given general anesthesia. Surgery typically lasts about 3 to 5 hours. Your doctor makes a large incision in your chest. You are placed on a heart-lung machine during the surgery. Blood is circulated outside of the body and oxygen is added to it using a heart-lung (cardiopulmonary bypass) machine. To protect the heart muscle from damage during surgery to replace the heart valve, the heart may be cooled to slow or stop the heartbeat. The damaged mitral valve is either repaired or removed and replaced with an artificial (prosthetic) heart valve.

The decision between repairing or replacing the valve depends on the type of damage to the mitral valve. For instance, repair is more successful if there is limited damage to certain areas of the mitral valve flaps (leaflets) or to the tough fibers that control movement of the mitral valve leaflets (chordae tendineae). 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.

To repair the heart valve, the surgeon may:

• Reshape the valve by removing excess valve tissue.
• Add support to the valve ring by adding tissue or a collar-shaped structure around the base of the valve.
• Attach the valve to nearby cordlike heart tissues (chordal transposition).

Heart valve replacement surgery involves the removal of the badly damaged valve. The valve is replaced with a plastic or metal mechanical valve, or a bioprosthetic valve, which is usually made from pig tissue. The damaged valve is cut out, and the new valve is sewn into place.

People who receive a mechanical heart valve are more likely than those who receive a bioprosthetic heart valve to develop blood clots in the heart. The clots may break loose, travel to the brain, and cause a stroke. So if you have received a mechanical heart valve to treat severe MR, you will need to take medicine for the rest of your life to prevent clots from forming (anticoagulant medicine).

In some cases, a plastic or metal valve may be preferred if you are already taking anticoagulants for other reasons, such as atrial fibrillation.

Before you have aortic valve replacement surgery, you and your doctor will decide on which type of valve is right for you. For help with this decision, see:

Heart valve problems: Should I choose a mechanical valve or tissue valve to replace my heart valve?

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