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What is mitral valve repair and replacement?

Mitral valve repair and replacement are cardiac surgical procedures used to treat structural heart disease, specifically stenosis (narrowing) or regurgitation (leakage) of the mitral valve. The mitral valve, named for its resemblance to a mitre of a bishop, enables blood to circulate between the two left chambers of the heart.​ If blood cannot pass through or leaks backward, pressure is increased in the lungs, which leads to an increase in fluid that causes shortness of breath—also known as congestive heart failure.

Historically, complex open-heart surgery was the only option used to repair and replace valves. Today, minimally invasive procedures have become the preferred way for people who are considered at risk for open-heart surgery, either because of their age or other health conditions. While the number of candidates for less-invasive procedures has grown in the past few years, they are not suitable treatments for everyone. Before you have valve surgery, you and your doctor will decide on which type of procedure is right for you.

Why it's done

Heart valve disease causes the heart to pump harder to circulate the right amount of blood through the body. If left untreated, it can reduce a person’s quality of life and become life-threatening. In many cases, valves can be surgically repaired or replaced, restoring normal function and allowing you to return to normal activities.

Advantages of mitral valve surgery:

  • Lower risk of complications
  • Better long-term survival
  • Decreased need for long-term use of blood thinners
  • Preserved heart muscle strength

Our approach

Every valve disease diagnosis is unique, which is why our team of cardiologists and cardiac surgeons work together to develop personalized treatment plans for each patient. They meet frequently to share cases and ideas, and closely review every step of each patient's care.

We are one of the few care teams in the nation with the latest in minimally invasive heart treatments for all heart valves. As trusted experts in innovative procedures and techniques, our patients are able to receive the full range of options for heart surgery, including:

  • Traditional open-heart surgery
  • Minimally invasive heart surgery
  • Minimally invasive robotic heart surgery
  • Transcatheter valve repair or replacement

Why choose us?

Northwell Health is one of the nation’s largest healthcare systems and the first in New York to offer minimally invasive heart valve surgery, and we continue to remain at the forefront of valve repair and replacement. That's why our physicians are often selected by medical device companies to teach new surgical techniques at hospitals around the world. Our advanced expertise and successful outcomes allow us to offer the latest valve replacement technologies, including the newest research and clinical trials.

Research at Northwell

We are dedicated to leading the way in minimally invasive valve surgery through medical research and by providing access to exclusive clinical trials and groundbreaking treatments. Our surgeons are at the forefront of leading-edge technology, pioneering new procedures that help patients recover faster and live longer. 

Northwell hospitals have successfully implanted Abbott’s Tendyne Transcatheter Mitral Valve Replacement (TMVR) system as part of a clinical trial to replace a leaky mitral valve without open heart surgery—the first such procedure in the Northeast. The minimally invasive device is the first that can be repositioned and fully retrieved, allowing more precise implantation and helping improve patient outcomes. To learn more or participate in this clinical trial, contact Christina Brennan, MD, vice president of clinical research at Northwell Health at (631) 968-3016 or [email protected].

In addition to using Abbott technology, our hospitals are actively involved in clinical studies with minimally invasive Medtronic Intrepid™ technologies for valve repair and replacement, including Cardioband, APOLLO and upcoming PASCAL trials.

Learn more about cardiac surgery research and clinical trials here.

Success statistics

Quality is something we take seriously at Northwell Health. Our care teams are 100 percent devoted to delivering world-class heart care, and others agree. It’s why third-party organizations like the New York State Department of Health (DOH) and the Society of Thoracic Surgeons (STS) continually recognize our programs for cardiac excellence.  

In fact, for the seventh consecutive time, the DOH report has recognized our programs as having the state’s best outcomes for certain types of open-heart surgery. In their analysis, they looked at risk-adjusted outcomes and survival rates for patients undergoing surgeries for isolated coronary artery bypass grafting (CABG), the repair or replacement of heart valves, or both. 

The Society of Thoracic Surgeons has also developed a comprehensive quality rating system for cardiac surgery among hospitals across the country. In the current analysis of national data, several Northwell hospitals were awarded the highest tier of "Three Star," and several others follow with an also impressive “Two Star” rating for quality care.

Risk factors

As with any surgery or procedure, possible risks are involved in mitral valve surgery. These risks may be related to certain factors such as your age and current medical conditions. Speak with your cardiologist to discuss any possible risks and/or complications.

Types

Traditional open-heart surgery

Open-heart surgery can be performed to repair or replace a mitral valve. It is a major operation during which the surgeon will open the chest to access the heart. During the procedure, you will be put on a heart lung machine that mimics the function of the heart and lungs by temporarily taking on their function so that the surgeon can work in a bloodless surgical field.  

Full recovery takes about two to three months. Most patients are able to drive in about three to eight weeks after surgery. Your doctor will provide specific guidelines for your recovery and return to work, including specific instructions on activity and how to care for your incision and general health after the surgery.
 

Minimally invasive surgery

Unlike traditional open-heart surgery, minimally invasive heart valve surgery is performed through a small incision(s) in the chest. Using specialized instruments and advanced video technology, your surgeon is able to see and operate inside your body without opening the chest or spreading the ribs.

Your cardiac surgeon will review the results of your medical history and your current condition to determine whether you are a candidate for minimally invasive surgery. During this process, our surgical care team will carefully compare the advantages and disadvantages of minimally invasive techniques versus traditional surgical techniques.


Minimally invasive robotic surgery

Robotic surgery for valve repair and replacement is a minimally invasive alternative to traditional open surgery. Instead of one large incision, your surgeon will operate through a few tiny ones—allowing for faster recovery with less pain, scarring and blood loss than regular surgery. Robot-assisted surgery may also be an option if you’re not a candidate for traditional surgery.

During the procedure, your surgeon uses highly flexible 3D cameras that provide a high definition view. This view far exceeds what’s visible to the human eye during traditional surgery. Additional benefits of minimally invasive robotic surgery include lower risk of infection, improved recovery time and earlier return to normal activities.

Transcatheter mitral valve repair and replacement

Transcatheter mitral valve repair, or TMVRe, is a minimally invasive treatment alternative to traditional open-heart surgery, in which a permanent device (known as a MitraClip) is guided to the heart through the femoral vein. The device is then positioned to grab the leaflets of the valve and the catheter is removed. This procedure repairs the valve’s ability to close more completely and reduces leakage of blood to the lungs.

Transcatheter mitral replacement, or TMVR, is a less invasive, hybrid approach to traditional open-heart surgery, available to high-risk or inoperable patients through an investigational trial. A small incision is made through the left chest wall between the ribs. A valve is implanted directly into the heart, replacing the native mitral valve. This first-of-its-kind device technology offers patients with severe regurgitation a life-saving treatment option without open-heart surgery.

TMVRe, and now potentially with TMVR, results in a smaller incision, causing less pain and a shorter recovery time when compared to open-heart surgery. Depending on your personal care, it’s possible that your recovery could be days or weeks versus the months of recovery associated with open-heart surgery.

Follow-up care

During the first few months after surgery, follow-up visits and post-surgical testing at your doctor’s office is strongly encouraged. While medications and surgery will treat heart valve disease, they will not fully cure it. You will always need to see your doctor for lifelong follow-up care to make sure your heart valve functions as it should.
 

Life after surgery

How you feel after surgery will depend on your overall health and how well you take care of yourself. It's important to maintain your heart health after surgery by making positive lifestyle changes. This may include:

  • Quitting smoking
  • Treating high cholesterol
  • Managing high blood pressure and diabetes
  • Exercising regularly
  • Maintaining a healthy weight
  • Eating a heart-healthy diet
  • Participating in a cardiac rehabilitation
    program, as recommended
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