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Mitral Valve Repair at Cleveland Clinic
Cleveland Clinic surgeons have performed more than 11,000 mitral valve repairs, the world’s largest single center experience. In 2006, hospital mortality for primary isolated mitral valve repair was 0%. Nearly all isolated mitral valve repairs can be performed minimally invasively.
The majority of patients having mitral valve surgery at Cleveland Clinic travel to Cleveland from outside Ohio, taking advantage of our expert staff that facilitates and simplifies the experience.
Dr. A. Marc Gillinov answers the most common questions patients ask when they visit Cleveland Clinic for their mitral valve surgery.
Questions and Answers about Mitral Valve Disease and Valve Repair
What are the symptoms of a leaking mitral valve?
Many patients with mitral valve disease are asymptomatic (have no symptoms), even with a leak that is severe. When symptoms develop, they include shortness of breath, fatigue, loss of energy, swelling of the ankles and palpitations (extra or skipped heart beats).
How is a leaky mitral valve diagnosed?
The first step involves listening with a stethoscope. Using a stethoscope, the doctor hears a murmur, which represents turbulent blood flow across an abnormal valve. The diagnosis is confirmed by an echocardiogram. Ultrasound is used in an echocardiogram to allow the doctor to visualize the heart valves and determine the severity and cause of the leak. In most patients, a standard transthoracic echocardiogram (a probe placed on the skin of the chest) is adequate to visualize the valve. Sometimes a transesophageal echocardiogram (a probe passed through the mouth into the esophagus) is necessary to more closely visualize the valve; this is an outpatient procedure.
What is mitral valve prolapse?
Mitral valve prolapse is a common condition in which the mitral valve leaflets are floppy or loose. Mitral valve prolapse is diagnosed by echocardiography. Most patients with mitral valve prolapse do not have a leaky valve and do not require surgery. When a valve with prolapse has a severe leak, surgery should be considered.
Mitral Valve Prolapse
What are the indications for surgical repair of a leaking mitral valve?
Surgery should be considered when the leak is severe. In most facilities, the regurgitation (leak) is graded on a scale from 0 to 4, with 0 being no leak and 4 being a severe leak.
Surgery should be considered in virtually all patients with a leak that is graded as a 4 (severe) and in some patients with a leak that is graded as a 3 (moderately severe). When a patient with mitral regurgitation develops symptoms, a decrease in heart function, or an increase in heart size, surgery is recommended. Surgery should also be considered when a patient develops atrial fibrillation, which is an irregular heartbeat. Surgery is also recommended in many asymptomatic patients who have a severe leak; in these patients, surgery improves long-term survival.
What is the chance that a leaky mitral valve can be repaired?
Nearly 100%. The most common cause of mitral regurgitation is a condition called degenerative mitral valve disease—this is also called mitral valve prolapse, myxomatous mitral valve disease, and a floppy mitral valve. Such valves can be repaired (rather than replaced) in more than 95% of patients. Cleveland Clinic heart surgeons have the world’s largest experience with mitral valve repair.
What is the chance that a leaky mitral valve can be repaired minimally invasively?
Nearly 100%. When a patient requires isolated mitral valve surgery for a degenerative valve, at Cleveland Clinic we can perform the operation through a 2 to 4 inch skin incision in 95% of cases. We offer several different minimally invasive approaches, including a small incision on the right chest, a small incision in the mid-line, and robotically assisted procedures. Expertise with several approaches enables us to determine the best procedure for each patient, optimizing results.
What is the risk of mitral valve surgery?
For asymptomatic patients having mitral valve repair, the operative risk is approximately 1 in 1000. Risk in symptomatic patients remains well under 1%. The presence of coronary artery disease or other conditions that require surgical treatment will affect your individual risk. Ask your doctor about your surgical risk.
What is the durability of a mitral valve repair?
After mitral valve repair, 95% of patients are free of reoperation at 10 years, and this statistic is similar at 20 years. Thus, reoperation is uncommon after a successful mitral valve repair. An echocardiogram is recommended annually to assess valve function. In addition, patients who had valve surgery must take steps to prevent infection and reduce the risk of endocarditis (an infection of the valve).
Why is it important to have my surgery at a center with a large experience in 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.
Advantages of Mitral Valve Repair—Better early and late survival, improved lifestyle, better preservation of heart function, lower risk of stroke and infection (endocarditis), no need for blood thinners (anticoagulation)
Mitral valve repair is more challenging than mitral valve replacement, and experienced surgeons are more likely to be able to repair the valve and ensure an excellent outcome.
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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 e-mail, 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.
