Alternative Approaches to Mitral Valve Repair

The human heart consists of four chambers. Blood goes into the right chambers, then receives oxygen in the lungs and travels to the left chambers. Four valves, or flaps, control how the blood flows into and out of the chambers: mitral valves and aortic valves control the blood from the lungs. Problems arise with the mitral valve when a condition called “prolapse” results in regurgitation--a leak or backflow of blood.

The leak requires more effort from the heart to pump blood. Over time, the heart may fail.

Diagnosis

• Symptoms of mitral valve regurgitation may include shortness of breath, pain in the chest, irregular heartbeat and fatigue. Your doctor can diagnosis mitral valve defects and decide whether or not surgery is required. An echocardiogram is the test commonly used to detect severe valve regurgitation. Early diagnosis and surgery, particularly valve repair, can help prevent further heart damage.

Remedies

• In severe cases of mitral valve regurgitation, open-heart surgery is required to correct the problem. Surgical intervention can consist of either repair of the valve or replacement with a mechanical valve or a “biological” valve. The latter valves are either porcine, consisting of tissue from a pig, or bovine, which is tissue from a cow. Biological valves are not as durable as mechanical valves and may have a lifespan of just a few years in a young person to a lifetime in a patient past 70 years of age.

Mitral Valve Repair

• In some patients, the valve is so badly damaged that it must be replaced.

  According to The Mitral Valve Repair Center at The Mount Sinai Hospital, however, repair of the patient’s own valve is considered preferable to replacement in that complications after valve repair surgery are fewer than after replacement surgery. Repair also avoids the necessity for long-term use of blood thinners.

  Valve repair may entail simply removing the defective portion of the valve and then closing the valve. A more elaborate reconstruction may involve sutures or installation of a supporting ring.

Minimally Invasive Surgery

• In traditional open-heart surgery, an incision of 4 to 6 inches is made over the sternum, or breastbone. Then the surgeon saws through the breastbone and separates the bone to reach the heart.

  “Minimally invasive surgery,” using a smaller incision of just 3 to 4 inches, and a smaller spreading of the breastbone, is an option for some patients and results in a less noticeable scar, usually within the cleavage of women. Patients may experience quicker healing and less pain when surgery is performed through smaller incisions. If the surgeon finds that he cannot safely perform the repair through the small opening, he can simply extend the incision farther and separate the rest of the sternum.

Other Surgical Alternatives

• A thoractomy is a method in which the incision is made on the right side of the chest, resulting in a scar underneath the breast. This type of incision may limit access to the valve and make a successful repair difficult to perform.

  So-called “robotic surgery” is performed through several small incisions, using a robot. This method also limits accessibility and successful valve repair.