Have you been told you need mitral valve surgery? Mitral Valve Repair: A Conversation with Dr. Gillinov will answer your questions!

Written with A. Marc Gillinov, M.D.

Your mitral valve

Mitral Valve Repair at Nation's Number One Heart Hospital

Cleveland Clinic heart surgeons have the world’s largest experience with mitral valve repair, the best option for most patients with a leaking mitral valve (mitral regurgitation).

At Cleveland Clinic, nearly all leaking mitral valves are repaired rather than replaced, providing patients with ideal outcomes. The majority of these operations are performed minimally invasively, ensuring rapid recovery.

In 2006, patients traveled to Cleveland Clinic from all 50 states and 11 foreign countries to have mitral valve surgery.

Advantages of Mitral Valve Repair

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 better long-term survival, better preservation of heart function, lower risk of complications, and usually avoids the need for long-term use of blood thinners (anticoagulation). For these reasons, Cleveland Clinic surgeons are committed to mitral valve repair.

Minimally Invasive Mitral Valve Repair

Cleveland Clinic surgeons have been pioneers in the development of minimally invasive techniques for mitral valve repair. Today, nearly all mitral valve repairs can be performed through a 2 to 3 inch incision on the right side of the chest. This approach may be supplemented by use of a surgical robot. A second minimally invasive approach through the center of the chest is available for selected patients whose anatomy is best addressed through this incision. Minimally invasive approaches may also be used for patients who require aortic valve or tricuspid valve surgery, alone or in combination with mitral valve surgery. In addition, Cleveland Clinic is a leader in research into percutaneous approaches to mitral valve repair, which may bring additional options to patients in the future.

Learn about minimally invasive mitral valve repair: types of incisions; surgical options; photos and videos

Mitral valve repair surgery - Surgical techniques

Cleveland Clinic surgeons have been instrumental in the development and application of modern mitral valve repair techniques. Problems with the posterior leaflet are generally corrected by a small resection of the abnormal portion of the valve. Anterior leaflet dysfunction is managed by creation of new chords or chordal transfer. Anterior leaflet repair techniques are technically challenging, requiring a skilled and experienced surgical team to achieve the best result. All repairs include an annuloplasty, which is a complete or partial ring placed around the circumference (rim) of the valve.

Mitral valve posterior leaflet prolapse - valve repair surgery

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

Triangular Resection Mitral Valve Repair
Ruptured chords at free edge of posterior leaflet. Region to be resected is indicated.	Abnormal 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 complex and requires greater surgical expertise. Two techniques used for correction of anterior leaflet prolapse are transfer of normal chords from another part of the valve (chordal transfer) and creation of artificial chords.

Mitral Valve Repair—Special Situations

Mitral valve repair and atrial fibrillation

Many patients with mitral valve disease have atrial fibrillation, an abnormal heart rhythm. At the time of minimally invasive mitral valve repair, Cleveland Clinic surgeons perform an ablation (Maze procedure) in such patients with the intent of curing the atrial fibrillation.

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, offering excellent long-term durability and the important advantages that go with mitral valve repair.

Previous heart 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 reoperative settings, Cleveland Clinic surgeons can safely and effectively repair nearly all leaking mitral valves.

Mitral valve repair for endocarditis

When infection damages a mitral valve (endocarditis), repair is particularly challenging. With extensive experience in such patients, Cleveland Clinic surgeon achieve successful repair in the majority of patients who have had endocarditis.

Mitral calcification

Mitral valve repair surgery videos

Click here to view the following valve surgery videos: (page may take a couple minutes to load)

• Mitral valve repair by posterior leaflet resection
• Mitral valve repair by sliding leaflet repair
• Mitral valve repair by chordal transfer to treat anterior leaflet prolapse

For more information:

• Mitral valve repair frequently asked questions - answered by one of our surgeon experts!
• Latest Innovations in Mitral Valve Surgery- Transcript of webchat with Dr. Gillinov 4/2007
• Our surgical outcomes
• Treatment options: heart valve surgery
• Valve surgery - past, present and future
• Heart surgery at the Cleveland Clinic
• Valve surgery videos
• More Valve Surgery information

If you have questions or need more information:

To obtain a surgical consultation, or if you have additional questions or need more information, you may contact us by email, using the Contact Us Form. Please state "Heart Center" in the Question or Comment Section.

You may also call the Heart & Vascular Institute Resource Nurse at 216/445-9288 or toll-free 866/289-6911. Webmail and phone calls are answered between 8:30 am to 4:00 pm on regular business days.

• Gillinov AM, Banbury MK. Pre-measured artificial chordae for mitral valve repair. Ann Thorac Surg 2007; in press.
• Gillinov AM, Svensson LG. Ablation of atrial fibrillation with minimally invasive mitral surgery. Ann Thorac Surg 2007; in press.
• Gillinov AM, Liddicoat JR. Percutaneous transvenous mitral annuloplasty. Eurointerventions 2007.
• Gillinov AM. Is ischemic mitral regurgitation an indication for surgical repair or replacement? J Heart Fail Rev 2006;11(3):231-239.
• Gillinov AM, Liddicoat JR. Percutaneous mitral valve repair. Seminar Thoracic and Cardiovasc Surg 2006 Summer;18(2):115-121.
• Gillinov AM. Chordal transfer for repair of anterior leaflet prolapse. Multimedia Manual of Cardiothoracic Surg, 2005.
• Gillinov AM, Cosgrove DM. Current status of mitral valve repair. Am Heart Hosp J, 2003;1:47-54.
• Gillinov AM, Faber CN, Houghtaling PL, Blackstone EH, Lam BK, Diaz R, Lytle BW, et al. Repair versus replacement for degenerative mitral valve disease with coexisting ischemic heart disease. J Thorac Cardiovasc Surg, 2003;125:1350-62.
• Gillinov AM, Banbury MK, Cosgrove DM. Hemisternotomy approach for aortic and mitral valve surgery. J Card Surg, 2000;15:15-20.
• Gillinov AM, Banbury MK, Cosgrove DM. Is minimally invasive heart valve surgery a paradigm for the future? Curr Cardiol Rep, 1999;1:318-22. Review.
• Gillinov AM, Cosgrove DM, Blackstone EH, Diaz R, Arnold JH, Lytle BW, Smedira NG, Sabik JF, McCarthy PM, Loop FD. Durability of mitral valve repair for degenerative disease. J Thorac Cardiovasc Surg 1998;116:734-43.