Mitral Valve Repair and Replacement

The heart has four valves that control the flow of blood to the heart: the aortic, mitral, tricuspid and pulmonic (also called pulmonary) valves. The mitral valve controls blood flow from the left atrium into the left ventricle. Two common mitral valve conditions caused by heart valve disease occur when the heart valve does not function properly:

  • Mitral valve prolapse
  • Mitral valve stenosis

In mitral valve prolapse, the valve's flaps do not close all the way, causing blood to leak backwards, a condition known as regurgitation. Mitral valve stenosis occurs when the opening of the valve narrows, reducing blood flow.

Cardiac surgeons at the Brigham and Women’s Hospital (BWH) Heart & Vascular Center are high-volume performers in all types of heart valve surgery, including mitral valve repair and replacement. Our team has performed over 4,000 mitral valve repairs since 1971. In 1996, we launched our minimally invasive mitral valve repair surgery program and have performed over 1,000 since then. In total, we've performed over 2,600 minimally invasive valve surgeries.

This experience and their collaboration with a multidisciplinary team of specialists through the Structural Heart Disease Program enables our surgeons to handle the most complicated cases, with a range of treatment options that improve the lives of cardiac patients throughout the world. These include procedures that allow patients to avoid the use of long-term anticoagulants and minimally invasive treatment options that offer patients a faster recovery with less pain.

With 47,000 outpatient visits each year, the Heart & Vascular Center is one of the largest in the United States, treating over 7,000 inpatients and performing more than 8,000 procedures annually at our state-of-the-art Shapiro Cardiovascular Center.

Mitral Valve Repair and Replacement

Mitral Valve Repair and Replacement Procedures

Mitral Valve Repair Surgery

Cardiac surgeons at BWH’s Heart & Vascular Center offer a variety of surgical techniques to repair heart valves to enable them to open and shut efficiently. Surgical approaches include the following:

  • Decalcification to remove calcium to prevent leakage
  • Repair of structural support to reshape fibrous strings that support the valves, or the fibrous ring that supports the valve (the annulus)
  • Patching holes to stop valve leakage
  • Reshaping the valve leaflets to allow the valve to open and close better

Mitral Valve Replacement Surgery

When your surgeon determines that your heart valve cannot be repaired, he or she may recommend mitral valve replacement surgery. Damaged heart valves are replaced with a choice of substitute valves including:

  • Mechanical valves made of durable synthetic materials such as graphite and pyrolytic carbon. These last as long as 30 years and recipients must take lifelong blood thinning medications.
  • Biological valves last for 10 to 20 years and are made from animal tissue or donated human tissue. A homograft is a valve from a donated human heart. Patients do not require long-term blood thinning medications.
Minimally Invasive or Open Mitral Valve Repair and Replacement Surgery

Mitral valve repair or replacement surgery may be performed with minimally invasive surgery or traditional (open) heart surgery. Surgeons in the Heart & Vascular Center use their advanced training and experience to perform varied surgical options – unique to each patient - when operating on heart valves.

We have particular experience and expertise in endoscopic mitral valve surgery, a minimally invasive approach that uses small incisions on the right side of the chest.  Our surgeons are ranked among the world’s leading performers of mini-thoracotomy procedures.

Minimally invasive heart surgery uses small incisions and has fewer post-operative complications, allowing patients to recuperate faster with less pain. These include:

  • Mini thoracotomy uses a small incision through the ribs
  • Mini sternotomy is done through a small opening that goes from the top of your breastbone down to the third rib.

Open heart surgery means cutting skin and tissues with a wide incision so that your surgeon has a full view of your heart. Types of open surgery are:

  • Sternotomy involves a nine-inch incision made down the center of your chest separating your breastbone.
  • Thoracotomy involves a nine-inch incision made in your rib cage from under the arm around to the back.

Watch this video of cardiac specialists at Brigham and Women's Hospital (BWH) discussing innovations in coronary disease treatment .

Why Have Mitral Valve Repair or Replacement Surgery?

Surgery may be recommended on your mitral valve if:

  • You have mitral regurgitation
  • You have mitral stenosis
  • Your valve has developed an infection (endocarditis)
  • You have severe mitral valve prolapse that is not controlled with medicine
  • You have heart symptoms, such as chest pain, shortness of breath, fainting spells or heart failure
  • Tests show that the changes in your mitral valve are affecting heart function

Learn more about heart valve disease.

What You Should Expect

The Heart & Vascular Center is located in the Shapiro Cardiovascular Center, across the street from BWH’s main 75 Francis Street entrance. The Heart & Vascular Center brings together the full range of services in one location, fostering seamless and coordinated care for all cardiovascular patients.

Prior to surgery, you will be scheduled for a visit to the Watkins Clinic in the Shapiro Cardiovascular Center for preoperative information and tests.

The day of surgery, your care will be provided by surgeons, anesthesiologists and nurses who specialize in mitral valve disease. The Heart & Vascular Center is home to one of the most advanced hybrid operating rooms in the country. After surgery, you will recover in the post-surgical care unit where you will receive comprehensive care by an experienced surgical and nursing staff.

During your surgery, family and friends can wait in the Shapiro Family Center where staff members will provide surgery updates.

Multidisciplinary Care

In addition to our cardiac surgeons, patients also benefit from the teamwork of medical cardiologists, interventional cardiologists, cardiovascular imaging experts and radiologists, and anesthesiologists, all experts in cardiovascular disease. They work alongside nurses, physician assistants, physical therapists, dietitians and social workers to achieve outstanding outcomes for our patients.

Resources

Learn more about heart valve repair and replacement surgery in our health library.

Visit the Kessler Health Education Library in the Bretholtz Center for Patients and Families to access computers and knowledgeable staff.

Access a complete directory of patient and family services.

Learn about the Watkins Clinic in the Shapiro Center.

Download Cardiac Surgery: A Guide for Patients in English or Spanish.

LEARN MORE ABOUT BRIGHAM AND WOMEN’S HOSPITAL


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