What Is Mitral Valve Repair

Overview

Mitral Valve Repair at Cleveland Clinic

At Cleveland Clinic we have the world's greatest experience with mitral valve repair, the best option for almost patients with a leaking mitral valve (mitral regurgitation).

Our surgeons have special expertise in mitral valve repair. Equally a upshot, at Cleveland Clinic, most all leaking mitral valves are repaired rather than replaced. A repair charge per unit of nearly 100% for patients with leaking mitral valves provides patients with ideal outcomes. And for those with isolated mitral valve issues, the majority of operations are performed robotically or minimally invasively, ensuring rapid recovery.

In 2019, patients traveled to Cleveland Dispensary from all 50 states and 103 countries for their cardiovascular care.

What are the symptoms of a leaking mitral valve?

Many patients with mitral valve affliction are asymptomatic (have no symptoms), even with a leak that is severe. When symptoms develop, they include shortness of breath, fatigue, loss of energy, swelling of the ankles and palpitations (actress or skipped heart beats).

How is a leaky mitral valve diagnosed?

The first step involves listening with a stethoscope. Using a stethoscope, the doc hears a murmur, which represents turbulent blood flow across an abnormal valve. The diagnosis is confirmed by an echocardiogram. Ultrasound is used in an echocardiogram to allow the doctor to visualize the heart valves and decide the severity and crusade of the leak. In most patients, a standard transthoracic echocardiogram (a probe placed on the skin of the chest) is adequate to visualize the valve. Sometimes a transesophageal echocardiogram (a probe passed through the mouth into the esophagus) is necessary to more closely visualize the valve; this is an outpatient procedure.

What is mitral valve prolapse?

Mitral valve prolapse is a common condition in which the mitral valve leaflets are floppy or loose. Mitral valve prolapse is diagnosed by echocardiography. Near patients with mitral valve prolapse do not have a leaky valve and do not require surgery. When a valve with prolapse has a severe leak, surgery should exist considered.

Mitral Valve Prolapse

What are the indications for surgical repair of a leaking mitral valve?

Surgery should be considered when the leak is severe. In most facilities, the regurgitation (leak) is graded on a scale from 0 to iv, with 0 being no leak and 4 beingness a severe leak.

Surgery should be considered in most all patients with a leak that is graded as a 4 (astringent) and in some patients with a leak that is graded as a iii (moderately severe). When a patient with mitral regurgitation develops symptoms, a decrease in middle office, or an increase in heart size, surgery is virtually always recommended. Surgery should also be considered when a patient develops atrial fibrillation, which is an irregular heartbeat. Surgery is also recommended in most asymptomatic patients who take a severe leak. In asymptomatic patients with severe mitral regurgitation, surgery improves long-term survival. In dissimilarity, waiting for the development of symptoms or changes in heart role tin leave patients with permanent heart damage.

What is the take chances that a leaky mitral valve tin be repaired?

Most 100%. The well-nigh common crusade of mitral regurgitation is a condition chosen degenerative mitral valve disease—this is too called mitral valve prolapse, myxomatous mitral valve affliction, and a floppy mitral valve. Such valves tin can be repaired (rather than replaced) in more than 95% of patients. Cleveland Clinic heart surgeons have the globe'due south largest feel with mitral valve repair.

What is the chance that a leaky mitral valve tin can be repaired minimally invasively?

Approximately threescore-80%. When a patient requires isolated mitral valve surgery for a degenerative valve, at Cleveland Clinic nosotros can perform the operation through a two to four inch skin incision in in the bulk of cases. Preoperative testing enables us to choose the safest approach for each patient. Nosotros offer several different minimally invasive approaches, including a minor incision on the correct breast, a small incision in the mid-line, and robotically assisted procedures. Expertise with several approaches enables the states to determine the best procedure for each patient, optimizing results.

Procedure Details

Minimally Invasive Mitral Valve Repair

Cleveland Clinic surgeons are pioneers in the development of minimally invasive techniques for mitral valve repair. Today, the majority of isolated mitral valve repairs can be performed through a ii-three inch incision on the right side of the breast. In many cases, nosotros can employ the surgical robot and limit incision size to 1 inch.

Full Sternotomy

Partial Sternotomy

Right Thoracotomy

Robotic

Several minimally invasive approaches are available to patients. Minimally invasive approaches may likewise be used for patients who require aortic valve or tricuspid valve surgery, lonely or in combination with mitral valve surgery. In addition, Cleveland Clinic is a leader in percutaneous (through the skin) approaches to mitral valve repair, which may lead to boosted treatment options in the future.

Advantages of minimally invasive approaches include faster recovery, less pain, reduced need for blood transfusion and ameliorate corrective outcome. We evaluate each patient for robotic and minimally invasive surgery and piece of work with the patient to choose the best and safest approach in each case.

Learn almost minimally invasive mitral valve repair: types of incisions, surgical options, photos and videos.

Mitral Valve Repair Surgery — Surgical Techniques

Cleveland Dispensary surgeons accept been instrumental in the development and application of modernistic mitral valve repair techniques. Bug with the posterior leaflet are generally corrected by a small series of chords or a small resection of the abnormal portion of the valve. Inductive leaflet dysfunction is managed by creation of new chords or chordal transfer. Inductive leaflet repair techniques are technically challenging, requiring a skilled and experienced surgical team to accomplish the best result. All repairs include an annuloplasty, which is a consummate or partial ring placed effectually the circumference (rim) of the valve.

Mitral Valve Posterior Leaflet Prolapse — Valve Repair Surgery

During mitral valve repair heart surgery, triangular resection is the technique used most often for posterior leaflet prolapse.

Triangular Resection Mitral Valve Repair

Ruptured chords at free edge of posterior leaflet. Region to exist resected is indicated.

Aberrant segment has been removed. Leaflet edges are sewn together.

Annuloplasty completes the repair.

Mitral Valve Anterior Leaflet Prolapse — Valve Repair Surgery

When there is mitral valve prolapse of the anterior leaflet, repair is more circuitous and requires greater surgical expertise. To correct inductive leaflet prolapse caused by a ruptured or elongated chord, we ordinarily create new chords out of Gore-Tex. These Gore-Tex chords more often than not last forever. A second technique used for correction of anterior leaflet prolapse is chordal transfer, which involves transfer of chords from another office of the valve to the area with aberrant chords. Both techniques provide excellent long-term results for patients.

Gore-Tex® Chord for Correction of Inductive Leaflet Prolapse

Ruptured Chord

Afterward Chordal Repair

Chordae may be synthetic from Gore-Tex® sutures. A Gore-Tex® suture is affixed to the head of the papillary muscle and and then passed through the free border of the unsupported anterior leaflet, providing back up.

Long-term immovability is splendid. The new chordae practise non rupture or elongate.

Chordal Transfer to Care for Anterior Leaflet Prolapse

Chordal transfer to correct anterior leaflet prolapse.

Posterior leaflet chordae are transferred to the unsupported complimentary border of the anterior leaflet. The posterior leaflet is then repaired. A cloth annuloplasty band completes the repair.

Mitral Valve Repair — Special Situations

Mitral Valve Repair and Atrial Fibrillation

Many patients with mitral valve affliction take atrial fibrillation, (an abnormal heart rhythm.) For these patients, at the time of mitral valve repair, Cleveland Clinic surgeons perform an ablation (Maze procedure) with the intent of curing the atrial fibrillation. In some patients with atrial fibrillation, a sternotomy (standard) approach may provide the best results.

Previous Mitral Valve Repair with Recurrent Mitral Regurgitation

In rare instances, a mitral valve repair may fail over time. While most surgeons replace such valves, Cleveland Clinic surgeons can frequently re-repair these valves, offer first-class long-term immovability and the important advantages that go with mitral valve repair.

Previous Center Surgery with Recurrent Mitral Regurgitation

Occasionally, a patient who has had previous bypass surgery, aortic valve surgery or other heart surgery develops a new problem with the mitral valve. In these re-operative settings, Cleveland Clinic surgeons can safely and effectively repair almost all leaking mitral valves.

Mitral Valve Repair for Endocarditis

When infection damages a mitral valve (endocarditis), repair is particularly challenging. Because of their all-encompassing experience with such patients, Cleveland Dispensary surgeons successfully repair the mitral valve in the bulk of patients who have had endocarditis.

Mitral Calcification

Occasionally, a patient with mitral regurgitation has all-encompassing calcium deposits on the valve leaflets or annulus. The calcium makes repair difficult and requires application of avant-garde surgical techniques and sound judgment. Cleveland Clinic surgeons accept the expertise to ensure excellent outcomes in patients with calcified mitral valves.

Mitral Valve Repair in Women with Breast Implants

Nosotros can usually perform a minimally invasive approach in women with breast implants. Working with a plastic surgeon, we remove the right breast implant through a small, cosmetic incision We so repair the mitral valve through the same incision. The plastic surgeon and then replaces the breast implant, ofttimes upgrading to a newer implant.

Risks / Benefits

Your Heart Valves

Advantages of Mitral Valve Repair: Why Repair Is Amend Than Replacement

Mitral valve repair is the best option for nearly all patients with a leaking (regurgitant) mitral valve and for many with a narrowed (stenotic) mitral valve.

Compared to valve replacement, mitral valve repair provides meliorate long-term survival, better preservation of centre function, lower risk of complications, and unremarkably eliminates the need for long-term use of blood thinners (anticoagulants). For these reasons, Cleveland Clinic surgeons are committed to mitral valve repair, when possible.

Advantages of Mitral Valve Repair:

• Ameliorate early on and late survival (Longer life!)
• Improved lifestyle
• Improve preservation of heart function
• Lower risk of stroke and infection (endocarditis)
• No need for claret thinners (anticoagulation)

Your Mitral Valve

Mitral Valve Chordae and Papillary Muscles

What is the hazard of mitral valve surgery?

For asymptomatic patients having mitral valve repair, the operative risk is approximately 1 in 1000. Run a risk in symptomatic patients remains well nether 1%. The presence of coronary avenue illness or other conditions that require surgical treatment will bear on your individual risk. Ask your doctor about your surgical chance.

What is the durability of a mitral valve repair?

After mitral valve repair, 95% of patients are gratuitous of reoperation at x years, and this figure is approximately 90% at xx years. Thus, reoperation is uncommon after a successful mitral valve repair. An echocardiogram is recommended annually to appraise valve role. In add-on, patients who had valve surgery must have steps to foreclose infection and reduce the risk of endocarditis (an infection of the valve).

Why is it important to have my surgery at a center with a large experience in mitral valve repair?

Mitral valve repair is the best choice for nearly all patients with a leaking (regurgitant) mitral valve and for many with a narrowed (stenotic) mitral valve.Compared to valve replacement, mitral valve repair provides meliorate long-term survival, ameliorate preservation of eye office, lower adventure of complications, and commonly avoids the need for long-term use of claret thinners (anticoagulation). For these reasons, Cleveland Clinic surgeons are committed to mitral valve repair.

Advantages of Mitral Valve Repair

• Better early and late survival
• Improved lifestyle
• Better preservation of heart role
• Lower chance of stroke and infection (endocarditis)
• No need for blood thinners (anticoagulation)

Mitral valve repair is more challenging than mitral valve replacement, and experienced surgeons are more likely to be able to repair the valve and ensure an splendid outcome.

Resources

Doctors who care for

Cleveland Dispensary has the nation's largest valve treatment programme.

Doctors vary in quality due to differences in preparation and feel; hospitals differ in the number of services available. The more complex your medical problem, the greater these differences in quality become and the more than they thing.

Clearly, the doctor and hospital that yous choose for complex, specialized medical care will have a direct impact on how well you do. To assistance you make this choice, please review our Miller Family Heart, Vascular & Thoracic Plant Outcomes.

Cleveland Clinic Center, Vascular & Thoracic Institute Cardiologists and Surgeons

• Valve Center
• Endocarditis Center
• Mitral and Tricuspid Valve Middle

The post-obit Mitral Valve Center surgeons specialize in mitral valve surgery:

• Marc Gillinov, MD* Department Chairman, Thoracic and Cardiovascular Surgery
• Daniel Burns, MD*
• Kenneth McCurry, MD

*Performs robotically assisted mitral valve surgery

The Mitral and Tricuspid Valve Center surgeons offers expertise and feel to provide the best outcomes possible.

Departments and Sections:

Choosing a md to care for your middle valve disease depends on where you are in your diagnosis and treatment. The following Heart, Vascular & Thoracic Establish Sections and Departments treat patients with Center Valve Disease:

Department of Thoracic and Cardiovascular Surgery : Surgeons in the Section of Thoracic and Cardiovascular Surgery are experts in the treatment of valve disease, including valve repair or replacement, minimally invasive centre valve surgery, and re-practice operations depending on the individual needs of the patient. For surgical review or more data, telephone call toll-free 877.843.2781 (877-8Heart1) 6 a.m. – nine p.m. EST, Monday - Friday or request an engagement online.

Department of Cardiovascular Medicine : Heart valve specialists in the following sections provide evaluation, medical management and life-long care of patients with heart valve affliction:

• Section of Cardiovascular Imaging
• Section of Clinical Cardiology

Call Cardiology Appointments at toll-costless 800.223.2273, extension 4-6697 or request an appointment online.

Considering traveling to Cleveland Clinic for heart surgery?

If y'all need a heart operation, you want the best surgeon with the best team at the best hospital. But traveling to the nation's best hospital for heart surgery is more comfortable and convenient than you might retrieve.

• Learn more well-nigh traveling for heart surgery

Need a second opinion?

Virtual Second Opinions connect you online with elevation Cleveland Clinic specialists who can review your diagnosis and offer additional consultation, quickly and securely.

Contact

To obtain a surgical consultation, or if you have boosted questions or need more than information, click here to contact u.s., chat online with a nurse or phone call the Miller Family Heart, Vascular & Thoracic Institute Resource & Data Nurse at 216.445.9288 or cost-free at 866.289.6911. We would be happy to help you.

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Our outcomes speak for themselves. Please review our facts and figures and if you have any questions don't hesitate to inquire.

Source: https://my.clevelandclinic.org/health/treatments/17240-mitral-valve-repair

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