Mitral Valve Surgery

Mitral valve surgery treats problems with your mitral valve caused by mitral valve disease. Mitral valve repair or replacement can be performed using traditional open-chest or minimally invasive approaches.

The heart valve experts at UPMC provide expert treatment for mitral valve disease — including mitral regurgitation, stenosis, prolapse, and infection — with outstanding outcomes. Our specialists are highly trained in the latest minimally invasive techniques for mitral valve repair and replacement surgery.

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What Is Mitral Valve Surgery?

Mitral valve disease occurs when your mitral valve doesn’t open and/or close correctly. When the valve does not open correctly, the heart must work harder to push blood through it. When the valve does not close normally, there is backward leakage of blood. Mitral valve surgery treats these problems.

Mitral valve procedures can be performed using traditional open-heart surgery or minimally invasive approaches. Depending on your condition, your doctor may repair or replace your mitral valve.

Types of mitral valve surgery

Mitral valve repair

If you have mitral valve disease, the preferred treatment is a repair of your own valve, rather than a mitral valve replacement.

Compared to mitral valve replacement, mitral valve repair provides better long-term survival, better preservation of heart function, lower risk of complications, and usually eliminates the need for long-term use of blood thinners. UPMC cardiac surgeons are committed to preserving your own mitral valve by performing a mitral valve repair whenever possible.

Is mitral valve repair major surgery?

Mitral valve repair is a complex surgical procedure. Depending on your condition, your surgeon may use an open or minimally invasive approach. Minimally invasive surgery is typically associated with a shorter recovery time, less pain, and fewer postoperative restrictions when compared to open-chest surgical procedures.

Mitral valve replacement

If your mitral valve is too damaged to be repaired, your surgeon may remove your damaged mitral valve and replace it with a bioprosthetic valve (made of cow or pig heart tissue) or a mechanical valve (made of metal).

Minimally invasive mitral valve surgery

Our cardiologists and cardiovascular surgeons have the skills and experience required to successfully perform mitral valve repair and replacement using advanced minimally invasive techniques.

Minimally invasive procedures access your valve through much smaller incisions without opening your chest. The benefits of these minimally invasive approaches include:

• Fewer postoperative restrictions.
• Less pain.
• Shorter hospital stay.
• Shorter recovery time.

Can you repair mitral valve without open-heart surgery?

Minimally invasive mitral valve treatment options include:

• Minimally invasive mitral valve repair/replacement through a mini right thoracotomy — Mitral valve repair surgery can be performed through a small incision and is sometimes referred to as a “mini-mitral.” During this procedure, your surgeon will make a small incision between your ribs on the right side of your chest and use special surgical instruments to access and repair your mitra A robot may used to assist with this procedure and allow for even smaller incisions.
• Mitral transcatheter edge-to-edge repair (TEER) — TEER treats mitral regurgitation using a catheter-like tube that is threaded through your femoral vein in your leg and into your heart. After the tube is in place, your doctor will use the MitraClip device to clip the leaflets of your mitral valve together, which helps to prevent the backflow of blood into your heart.
• Transcatheter mitral valve replacement (TMVR) — Our structural heart team is involved in numerous clinical trials testing the latest advances in catheter based minimally invasive procedures for repair and replacement. In transcatheter mitral valve replacement, a new valve is inserted through the femoral vein and deployed like a stent in place of the diseased valve.

Conditions we treat with mitral valve surgery

• Mitral valve prolapse (MVP).
• Mitral regurgitation (MR).
• Mitral stenosis (MS).
• Mitral valve endocarditis (an infection of your mitral valve).

Why Would I Need Mitral Valve Surgery?

You may need mitral valve surgery if your mitral valve isn’t working correctly — even if you don’t have any symptoms. Even if you do not have symptoms, mitral valve surgery may be recommended when valve disease is severe, the left ventricle begins to enlarge or dilate, or if the squeeze of the heart (ejection fraction) becomes weaker.

Who’s a candidate for mitral valve surgery?

You may be a candidate for mitral valve surgery if you have a damaged or diseased mitral valve. Your doctor may recommend mitral valve surgery to prevent future complications, even if you don’t have noticeable symptoms.

What Are the Risks and Complications of Mitral Valve Surgery?

Some people with severe mitral valve disease are at increased risk of complications or death from mitral valve surgery. Mitral valve surgery is an excellent treatment option, but it isn’t right for everyone.

For many people, mitral valve surgery carries a low risk of complications. However, as with any surgery, there are risks, including:

• Damage to the artery used for insertion of the valve.
• Infection.
• Major bleeding.
• Need for a pacemaker.
• Other serious life-threatening events or even death.
• Stroke.

What Should I Expect From Mitral Valve Surgery?

If your doctor recommends mitral valve surgery, our team of heart valve experts will start by doing a thorough exam. During your mitral valve surgery evaluation, you may meet with:

• A heart surgeon.
• An interventional cardiologist.
• Advanced practice providers.

Our experts use the latest diagnostic tests to learn about your heart valve condition, including:

• Electrocardiogram (ECG or EKG) — This test records the electrical activity of your heart, shows abnormal rhythms (arrhythmias or dysrhythmias), and can sometimes detect heart muscle damage.
• Echocardiogram (Echo) — This noninvasive ultrasound test uses sound waves to evaluate your heart's chambers and valves. The echo sound waves create an image on a monitor as an ultrasound transducer is passed over your heart.
• Two-dimensional echocardiogram (2D Echo) — This test uses ultrasound to display a cross sectional "slice" of your beating heart, including the chambers, valves, and the major blood vessels that exit from the left and right part of your heart.
• Transesophageal echocardiogram (TEE) — TEE is a form of echocardiography that is performed by inserting a probe with a transducer into your esophagus rather than placing the transducer on your chest as in a traditional echocardiogram. A TEE provides a clearer image of your heart because the sound waves do not have to pass through skin, muscle, or bone.
• Chest x-ray — A chest x-ray is a diagnostic test that uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film. An x-ray can show enlargement in any area of the heart.
• Cardiac catheterization — This diagnostic procedure involves inserting a tiny, hollow tube (catheter) through a large artery in your leg or arm leading to your heart to provide images of your heart and blood vessels. This procedure is helpful in determining the type and extent of certain valve disorders.
• Magnetic resonance imaging (MRI) — MRI is a diagnostic procedure that uses a combination of large magnets, radio frequencies, and a computer to produce detailed images of organs and structures within the body.
• CT angiogram — A CT angiogram is an imaging test that looks at the arteries that supply your heart muscle. This test uses a powerful x-ray machine to produce images of your heart and heart vessels.

Your doctor may also order other tests, such as:

• An exercise stress test.
• Lung function tests.
• Ultrasound of your carotid artery.
• Bloodwork and urine tests to look for signs of infection prior to valve replacement.

Before: How to prepare for mitral valve surgery

Your doctor will explain the mitral valve surgery procedure to you and give you a chance to ask questions. To prepare for mitral valve surgery, you should:

• Tell your doctor if you are sensitive or allergic to any medications, metals, iodine, latex, tape, or anesthetic agents (local and general).
• Tell your doctor about all medications (prescription and over-the-counter) and herbal or other supplements you are taking.
• Tell your doctor if you have a history of bleeding disorders or if you are taking any blood-thinning medications, aspirin, or other medications that affect blood clotting. It may be necessary to stop some of the medications prior to the procedure.
• Fast for a certain time before the procedure. Your doctor will tell you how long to fast (usually overnight).
• Have any tests that your doctor recommends. For example, your doctor may request a blood test prior to the procedure to determine how long it takes your blood to clot.

On the day of your mitral valve surgery procedure, be sure to bring your photo ID and health insurance card(s). Leave valuables such as cash and jewelry at home.

After your mitral valve procedure, you will stay in the hospital for 1-5 days, depending on the type of procedure you have. Your doctor will let you know how many nights you should expect to stay for the type of procedure you are having.

You should bring toiletries, a robe, slippers, a cell phone and charger, medications, and a change of clothes. You should also arrange for someone to drive you home from the hospital after you are discharged.

How long does mitral valve surgery take?

Your mitral valve surgery could take as little as an hour or up to several hours, depending on the type of procedure you are having. For less invasive approaches such as TEER or TMVR, you should expect to spend 1-2 hours in the recovery room before being transferred to your hospital room.

For robotically assisted mitral valve repair/replacement via mini right thoracotomy or open-heart surgery, patients are transferred to an ICU from the operating room and tend to remain in the ICU for 1-2 days before transferring to a regular floor.

During your mitral valve surgery

During mitral valve replacement surgery, your damaged valve will be repaired or replaced with a new valve. Your doctor may perform a minimally invasive procedure or an open-chest surgery, depending on your condition.

Depending on the type of procedure you are having, you may be placed under general anesthesia or connected to a heart-lung bypass machine that will take over the function of your heart and lungs during your operation.

Your doctor will provide you with more details about the approach he or she plans to use before surgery.

Recovery after mitral valve surgery

When your mitral valve procedure is completed, you will be moved to recovery for observation and monitoring. Your doctor will provide more information about your recovery and your hospital stay — including when you can resume your normal activities.

If you receive a mechanical mitral valve replacement, you will need to take blood-thinning medication called warfarin or Coumadin after mitral valve surgery. Follow your doctor’s instructions and go to all your follow-up appointments.

How long does it take to recover from mitral valve surgery?

If you have an open surgical procedure, your recovery may take up to three months. A complete recovery after a minimally invasive procedure typically takes about 4-6 weeks.

When to call your doctor about mitral valve surgery complications

You should call your doctor if you are experiencing any unusual symptoms, including:

• A fever of more than 100.0°F.
• Burning or pain in your chest.
• Difficulty breathing.
• Difficulty swallowing, throat pain, or bloody cough.
• New or increasing shortness of breath.
• Pain, redness, bleeding, drainage, or increased swelling at the incision site.
• Rapid or pounding heartbeat.
• Redness or rash on your chest or back.

What’s the prognosis after mitral valve surgery?

Most otherwise healthy patients continue to lead active, normal lives after mitral valve surgery.

What is the life expectancy after mitral valve surgery?

For most people, life expectancy after mitral valve surgery is the same as anyone else who does not have heart problems. Talk to your doctor if you have questions about your life expectancy after your mitral valve surgery procedure.

What’s the success rate of mitral valve surgery?

Mitral valve surgery success rates vary depending on the type of procedure you’re having. However, most people who have mitral valve surgery have outstanding outcomes, reduced symptoms, and improved quality of life.

Why Choose UPMC for Mitral Valve Surgery?

The cardiovascular specialists at UPMC are among the most experienced in Pennsylvania at performing mitral valve surgery and minimally invasive transcatheter mitral valve procedures. Our team regularly participates in the latest clinical trials and delivers outstanding treatment outcomes.

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By UPMC Editorial Staff. Last reviewed on 2024-10-01 by Elissa Castor, PA-C.