Watch: in my words
What is mitral regurgitation, and when does it need surgery?
Repair or replacement — why I repair whenever possible
Should I consider a MitraClip instead of surgery?
I have no symptoms — why operate now?
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The benefits of repair over replacement
- You keep your own valve and the cords and muscles that support it, instead of an artificial one.
- No lifelong blood thinner in most cases. Mechanical replacement valves require one for life; after a repair, blood thinners are usually needed only for a period of time.
- Nothing to wear out the way a tissue valve does. Tissue replacement valves have a limited lifespan.
- It’s the guideline-recommended approach. The 2020 ACC/AHA guideline gives repair in preference to replacement its strongest (Class 1) recommendation for severe degenerative mitral regurgitation when repair is feasible.
When to operate if you feel fine
Surgery is recommended even without symptoms once the heart muscle starts to show strain — an ejection fraction of 60% or less, or the left ventricle enlarging to 40 mm at the end of contraction. Before that point, guidelines say surgery may be considered when a valve center expects a better than 95% chance of a successful, durable repair with less than 1% expected mortality.
Questions to ask any surgeon
- How likely is it that my valve can be repaired?
- How many mitral repairs do you do, and how often do you end up replacing instead?
- What are your published, risk-adjusted results?
Sources for this section: 2020 ACC/AHA Valve Guideline, key points: mitral (ACC) · Northwestern Medicine — Mitral valve repair or replacement
Common questions
Will I need blood thinners after a repair?
Usually only for a period of time after surgery, not for life — one of the main advantages of repair over a mechanical valve.
Source: Northwestern Medicine — Mitral valve repair or replacement
Should I consider a MitraClip instead?
The clip (transcatheter edge-to-edge repair) is designed for people whose risk makes surgery too dangerous. Its results may not last as long as surgical repair, and guidelines note that for patients who can have surgery, surgical repair remains the standard. More on edge-to-edge repair.
Source: Duke Health — Ask these questions before mitral valve surgery · 2020 ACC/AHA Valve Guideline, key points: mitral (ACC)
How do I know a program does mitral surgery well?
Ask how many mitral operations they do each year, how often a planned repair becomes a replacement, and to see their published Society of Thoracic Surgeons results. STS reports risk-adjusted mitral results for every participating program.
Source: Duke Health — Ask these questions before mitral valve surgery · STS public report — our group at St. Luke’s
What will my recovery involve?
You may need mild pain medicine for a few weeks after going home. Return to daily activities takes about four weeks after minimally invasive surgery and eight to 12 weeks after open-chest surgery.
Source: Duke Health — Ask these questions before mitral valve surgery
When can I drive, lift and go back to work?
General guidance from the American Heart Association after heart surgery: no driving for six weeks (riding as a passenger is fine — stop to walk every two hours), no lifting, pushing or pulling more than 10 pounds for six weeks, and light work in about six to 12 weeks. Sex can usually resume once you feel comfortable, often two to four weeks after leaving the hospital.
When I close your breastbone with rigid plates, I release you from sternal precautions at 6 weeks. Your own plan depends on your operation, so we go over it before you leave.
Source: American Heart Association — How can I recover from heart surgery?
