Montefiore Einstein Center for Heart and Vascular Care – Surgical Services – Mitral Valve Repair and Replacement - New York

Valve repair and replacement is performed to improve the blood flow through a faulty valve. Although any valve in the heart can be repaired or replaced, the vast majority are performed on the mitral valve located on the left-side of the heart between the left atrium and left ventricle.

Valve Disease: The Problem

In healthy patients, blood returning from the lungs enters the left atrium (the upper left chamber of the heart) and through the mitral valve into the left ventricle (the lower left chamber of the heart). From the left ventricle, the blood is pumped through the aorta and out to the rest of the body.  In the hearts of patients with valvular disease, the mitral valve doesn't open or close properly. Patients with valves that interfere with adequate blood flow may notice a number of symptoms that compromise the quality of their daily lives, including:

• Fatigue
• Breathlessness
• Shortness of breath
• Trouble breathing during exercise

Valve disease compromises blood flow in one of two ways:

Stenosis
In stenotic valves, the leaflets that make up the valve stiffen. This narrows the valve opening and prevents smooth blood flow. This can cause dangerous increases in pressure within the heart and lungs.

Regurgitation
Regurgitation occurs when one or more of the leaflets enlarges or tears to the point the valve can no longer close with a tight seal, allowing blood to flow back through the valve once it has been pumped through. This condition is sometimes referred to as floppy valve syndrome.

There are a number of causes for this kind of wear and tear on the valve, including mitral valve prolapse, valve infections and myxomatous degeneration.

How are Valve Repairs Performed?

	Butterfly Repair of the Mitral Valve

The procedure for valve repair depends on the particulars of a patient's case. For example, a patient suffering from a narrowed valve would receive valve commissurotomy during which a surgeon would either stretch or cut into the leaflets or replace the valve. A patient with a floppy valve would receive valvuloplasty to tighten the seal and remove the abnormal valve tissue. At times, complex valve repair includes leaflet transfers.

In all cases, surgeons at the Montefiore Einstein Center for Heart and Vascular Care offer patients the most minimally invasive approach available. Depending on the circumstances, the Heart and Vascular Center's surgeons will use breast bone incisions that are up to two-thirds smaller than the traditional surgery. Alternatively, surgeons are able to perform valve repair through an incision between the ribs.

Repair Versus Replacement

Although the Heart and Vascular Center offers cutting-edge procedures for the full spectrum of mechanical and biological valve replacement, surgeons at the Center are dedicated to valve repair as a primary option. Since patients who undergo valve replacements may have to take blood thinners for the rest of their lives to prevent the replacement valves from wearing out, our surgeons focus on repairing the native valve.

When the valve is repaired, patients maintain their own tissue and don't need to take blood thinners. This is an attractive option for young women planning to become pregnant. The Heart and Vascular Center repairs the valves of more than 90 percent of its patients with mitral valve regurgitation.

Protecting your Valves During Routine Medical Procedures

Infections that affect valve function can happen to anyone. Patients who have existing valve conditions are at risk for contracting an infection during routine dental, obstetrics, gynecology and urology procedures, where there is a risk of bacterial release into the bloodstream.

Patients with existing valve conditions should talk to their doctors about taking antibiotics before undergoing these routine procedures. In many cases, the doctor may prescribe an oral antibiotic to be taken by the patient prior to dental work.

Teaching the Next Generations of Surgeons

Recently, the American College of Cardiology asked Dr. Robert Michler, Chairman of Montefiore-Einstein's Department of Cardiovascular and Thoracic Surgery, to submit a chapter on minimally invasive valve repair and a video lecture that includes narrated footage of Dr. Michler performing a minimally invasive valve repair, both with and without robotic assistance. These educational videos will be used for continuing education training for cardiologists and heart surgeons throughout the world.