With mitral valve repair, the natural valve remains in place, but your doctor makes changes to the valve’s leaflets to allow them to function more effectively. This procedure typically has fewer risks compared with mitral valve replacement.

Your heart’s mitral valve, which is located between the left atrium and the left ventricle, allows blood to flow from the atrium down to the ventricle, where it’s then pumped out to the lungs and the rest of the body.

When it’s operating normally, the mitral valve opens wide enough for the left ventricle to fill with blood before shutting tightly.

However, when the mitral valve isn’t able to open or close properly, a valve repair or replacement may be necessary to ensure healthy heart function. Mitral valve repair, when feasible, is often the preferred option, as it has a lower risk of complications compared with replacing the entire valve with a prosthetic one.

Mitral valve disease usually falls into one of two categories:

  • Mitral valve regurgitation: This means the mitral valve’s leaflets don’t close tightly, which allows blood to flow back up into the atrium from the ventricle. This condition is also known as a leaky valve.
  • Mitral valve stenosis: Mitral valve stenosis means the mitral valve has narrowed and won’t open properly. As a result, a reduced amount of blood enters the ventricle in between each heartbeat. This means less blood is available to be pumped out to the lungs and the rest of the body.

With mitral valve repair, the natural valve leaflets remain in place, but a doctor will make changes to the leaflets to allow them to open and close properly. Alternatively, a doctor may add a ring or artificial cords to the valve to stabilize and support it.

Mitral valve repair may be performed via small incisions in the chest, or by threading a catheter to the heart with tools that allow for the repair. This is known as a minimally invasive procedure. In some cases, however, mitral valve repair may need to be done with open heart surgery.

Mitral valve replacement, on the other hand, involves the removal of the valve that isn’t working properly. The affected valve is then replaced with either a mechanical valve or a biological valve made with cow, pig, or human tissue.

A valve replacement is often performed through open heart surgery. However, a 2017 report on mitral valve replacement notes that ongoing developments in minimally invasive and robotic mitral valve replacements mean fewer replacement procedures require open heart surgery.

This reduces some of the risks associated with open surgery and speeds up the recovery timeframe for valve replacement.

The goal of mitral valve repair is to restore the valve’s ability to open and close properly to ensure healthy blood flow from the left atrium to the left ventricle.

A repair procedure is usually necessary in cases of mitral valve regurgitation or mitral valve stenosis that are causing symptoms and affecting circulation and heart function.

Common mitral valve disease symptoms include:

If symptoms are mild and there’s no significant problem with blood flow through the heart, mitral valve repair may not be necessary. However, it you have mitral valve disease, it’s advisable to get periodic echocardiograms to make sure the condition isn’t getting worse. If valvular heart disease or symptoms progress, some type of intervention may be necessary.

When treating mitral valve regurgitation, mitral valve repair, when feasible, is preferred over mitral valve replacement. According to a 2019 study, mitral valve repair is associated with a lower mortality risk and a lower risk of other complications compared with mitral valve replacement. This is the case even in instances of severe regurgitation.

Mitral valve replacement may be the only option if the valve is severely damaged and cannot be repaired.

Mitral valve repair can be done in several ways, depending on the nature of the valve issue.

With heart valve surgery, you will be under general anesthesia and, once you’re asleep, you’ll be placed on a heart-lung bypass machine. This machine maintains your circulation and respiration throughout the procedure.

For minimally invasive procedures, several small incisions will be made in the chest. The surgeon will then use long instruments inserted into these incisions to repair the heart valve.

Another minimally invasive option involves the use of a catheter (a thin, flexible tube) that’s inserted into an artery in the groin. The catheter is then threaded up to the heart with tools that can repair the mitral valve.

If open surgery is required, a long, single incision will be made down the center of the chest.

Commonly performed mitral valve repairs include:

  • Balloon valvuloplasty: With this procedure, a balloon-tipped catheter is guided through a blood vessel and up into the mitral valve. The balloon is then inflated to widen a narrowed, stenotic valve.
  • Chordal replacement: With chordal replacement, artificial chords are attached to the valve leaflets and heart muscle to support the mitral valve. A 2018 study of chordal replacement found that the procedure, when done using a catheter, leads to excellent outcomes with reduced risks of complications associated with open surgery.
  • Ring annuloplasty: With ring annuloplasty, a ring made of cloth, metal, or tissue is placed around the valve’s natural ring to tighten it and prevent regurgitation.
  • Valve leaflet repair: With valve leaflet repair, the natural leaflets are trimmed, reshaped, or patched so that they’ll close securely.

Recovery from mitral valve repair will depend on several factors, such as your overall health and the type of repair that was performed. Generally, a full recovery takes approximately 4 to 8 weeks.

If you had open surgery that required the sternum (breastbone) to be broken to reach the heart, it will likely take 6 to 8 weeks before you can resume your normal activities. Minimally invasive procedures usually require less recovery time.

Make sure you fully understand what your recovery will involve before you’re discharged from the hospital. Get clear instructions on when you can resume activities like walking, driving, and exercising. During your recovery, it’s important to avoid heavy lifting and straining.

Regardless of what type of mitral valve repair you had, you may want to consider enrolling in cardiac rehabilitation, a program that teaches heart-healthy behaviors, such as:

  • dietary strategies that promote weight management and blood pressure control
  • exercises that can be done safely while also improving your cardiovascular fitness
  • medication adherence
  • stress management

Mitral valve repair is generally a safe procedure, but there are risks. If you have advanced heart disease or other chronic health conditions, you may be at a higher risk of complications.

Some of the most common risks associated with mitral valve repair include:

  • arrhythmia (heart rhythm disturbance)
  • bleeding complications
  • blood clot formation and possible stroke
  • infection
  • valve failure (more common with replacements than repairs)

Mitral valve repair is a commonly performed procedure with a good prognosis for most people. However, the success rate of mitral valve repair can vary, depending on the reason for the repair.

For instance, if a repair is done due to primary mitral valve regurgitation (malfunctioning valves are the primary cause), the success rate is typically very high. In this instance, according to research, long-term survival after repair is equivalent to that of people of a similar age in the general population.

On the other hand, repair for secondary mitral valve regurgitation (when the heart is enlarged and the valve leaks because it’s stretched), is less successful. Although mitral valve repair may not extend a person’s life in this instance, it may help improve symptoms.

If possible, try to have your repair done by an experienced cardiac surgeon at a hospital or medical center that performs a high volume of such procedures. These factors can contribute to better outcomes.

Mitral valve repair is often performed in cases of mitral valve regurgitation (a leaky valve) and is also common in the treatment of mitral valve stenosis (a stiff and narrowed valve). Valve repair is usually preferred over valve replacement.

Although there are always some risks associated with any heart procedure, mitral valve repair has an excellent track record of long-term success and improved mitral valve function for certain types of mitral valve disease.

If you have mitral valve disease and have symptoms, such as heart palpitations, chest pain, fatigue, or shortness of breath, talk with your heart doctor to find out if mitral valve repair is right for you.