Mitral Valve Repair Versus Replacement

Mitral valve repair techniques were developed in the 1970's and refined in the 1980's.  Mitral valve replacement was originally the preferred method of fixing a diseased mitral valve, but mitral valve repair is now regarded as superior to mitral valve replacement.  The main advantage of mitral valve repair over mitral valve replacement is better long-term results of mitral valve repair with low mortality rates.

Improved Results with Mitral Valve Repair
Mitral valve repair provides excellent long term results without the need for a second operation that is seen with mitral valve replacement.  One study evaluated 162 patients who received surgery between 1970 and 1984, and reported that 94% of patients did not need a second operation after 10 years, and 92% of patients did not need a second operation 20 years after the initial mitral valve repair (Reference).   Another study from the Cleveland Clinic noted that 93% of patients did not need a second operation after 10 years.  (Reference).

Why is Mitral Valve Replacement Sometimes Necessary?
Some mitral valves are so diseased that they cannot be repaired, and mitral valve replacement must be completed.  It is important to note that in the majority of cases, a mitral valve repair can be performed.  One study found that 95% of valves can be repaired (Reference).  Unfortunately there is still a large percentage of valves that are replaced instead of repaired.  Many surgeons are not experienced with mitral valve repair, and prefer to replace the valve

Other Benefits of Mitral Valve Repair
Anticoagulation medications are not necessary with mitral valve repair.  This is important as anticoagulation can lead to bleeding, which is especially dangerous if it occurs in the brain.  Other benefits of mitral valve repair include lower risk of endocarditis (infection of the heart valves) and better function of the heart after surgery.