Mitral Valve Procedures

Mitral valve procedures treat several conditions that affect how blood flows through your heart. They are:

• Mitral regurgitation — This condition is caused by a leaky mitral valve. This is when the valve is unable to close properly, allowing blood to flow back and forth between the chambers of your heart.
• Mitral stenosis — This condition is caused by a mitral valve that doesn’t fully open. The lack of movement from the valve restricts blood flow and retains blood in the chambers of your heart.

To fix these conditions, surgeons in the Sutter Health network have several ways to correct your mitral valve. Depending on your mitral valve’s condition, your valve may either be repaired or replaced. Your care team works together to find out which option is best for you.

Depending on your overall health and the risk determined by your care team, you may be a candidate for open heart surgery, non-surgical mitral valve repair (MitraClip^®) or mitral valve replacement (TMVR) procedures.

Open Heart Surgery

Open heart surgery is the most common procedure for mitral valve repair and replacement. It’s recommended for people who are in good health and are considered low-risk for the surgery.

On the day of the procedure, patients arrive and receive general anesthesia to sleep and make the surgery pain-free.

During the surgery, your surgeon makes a 10-inch-long cut in the middle of your chest. After that, your breastbone will be separated in order to see your heart. Once your surgeon has a clear view of your heart, a small cut is made on the side of it. Depending on what’s needed, the mitral valve can either be repaired or replaced.

All this occurs while your heart is stopped either by a heart-lung bypass machine or bypass pump. This machine does the work of your heart while it’s stopped.

If your surgeon can repair your mitral valve, you may have:

• Ring annuloplasty — Your mitral valve is repaired by sewing a ring of metal, cloth or tissue around the valve.
• Valve repair — The mitral valve’s three leaflets are trimmed, shaped or rebuilt.

If your surgeon needs to replace your mitral valve, you may have:

• Mechanical valves — Synthetic valves last the longest, but will require that you take blood-thinning medicine, such as warfarin (Coumadin) or aspirin, for the rest of your life.
• Biological valves — These valves are either from human or animal tissue and typically last up to 10 to 12 years. Blood-thinning medication may not be necessary.

After your surgeon either repairs or replaces your mitral valve, your heart is closed and you’re taken off the heart-lung machine. Your breastbone will be closed and held together with stainless-steel wires. It takes near six weeks for the bone to heal, and the wires will remain inside your bone.

Overall, patients who undergo open heart surgery should expect around nine to 12 weeks to recover.

Non-Surgical Mitral Valve Repair and Replacement

The minimally invasive mitral valve repair with a mitral clip (MitraClip^®) and mitral valve replacement (TMVR) procedures are designed for people who are considered at risk for open heart surgery.

Through a puncture in the right leg, surgeons place a tube into a vein that transplants the mitral clip or the new mitral valve to the heart. To make sure the mitral clip or the new valve is directed accurately and placed correctly, the surgical team uses an echocardiogram (echo) and X-ray guidance.

Once the heart is reached, the new valve or mitral clip is placed. The care team can instantly see if the procedure has worked. If the team is unhappy with the result, adjustments can be made immediately until the blood flow has been corrected.

Quick recovery is one of the benefits of these procedures. Typically people are up and walking the same day, and they’re released from the hospital the day after surgery.

If you’re interested in this procedure, please speak with your doctor or care team.