While medications may improve some symptoms of mitral valve regurgitation, there are no medications to effectively repair the leaky mitral valve. Currently, mitral valve repair or replacement (open-heart surgery) is the only option to repair the mitral valve. The American College of Cardiology and the American Heart Association recommend surgical intervention when a patient’s symptoms of heart failure fail to respond to medications. Generally this occurs when a patient’s ejection fraction (the portion of blood that is “ejected” from the ventricle with each heart beat) drops below 60% and their left ventricle is larger than 45 millimeters at rest.
During open-heart surgery, the surgeon makes an incision in the patient’s chest to expose the heart. The patient is placed on the heart-lung machine, the heart is stopped, the valve is exposed by an incision in the atrium and the surgeon repairs or replaces the mitral valve.
The decision to repair or replace the valve is dependent on the cause of the mitral regurgitation. For example, repair is generally preferred if there is limited damage to the mitral valve leaflets or the fibrous chords (chordae tendinae) that control the movements of the leaflets. Replacement is preferred for a patient with a hard, calcified mitral annulus (mitral valve base) or widespread damage to the valve and surrounding tissue.
For patients undergoing mitral valve repair, one or more methods may be used. For example, the surgeon may implant a device (annuloplasty ring or band) to support the valve. The surgeon may also remove some of the mitral leaflet to improve mitral function. Other techniques include joining mitral flaps (Alfieri Stitch) or reattaching the fibrous chords.
For mitral valve replacement, the surgeon removes the patient’s native mitral valve, and replaces it with either a bio-prosthetic valve (usually made from pig tissue) or a mechanical valve made of plastic or metal.