Heart Valve Repair (Valvuloplasty)
Valve repair may be done when a valve leaflet is floppy and prolapses. The procedure involves surgically separating, cutting out a section, or pleating a valve leaflet.In the last three decades, some surgeons have embraced surgical techniques to repair the damaged native valve, rather than replace it. These techniques were pioneered by a French heart surgeon, Dr. Alain F. Carpentier. A repair still involves major cardiac surgery but for many patients presents the major advantage of avoiding blood thinners and may provide a more durable result. Within the last decade, mitral valve repair for stenosis and regurgitation has increased dramatically and has greatly reduced both post-operative complications and the need for extensive anticoagulation therapy6,7. A significant advantage of repair is the potential for early intervention, which can provide a major impact on the natural history of the disease.
Mitral Valve Repair
The preferred treatment for patients with mitral valve disease is repair of their native valve. This requires special expertise, but the advantages for the patient are significant and include improved life expectancy, avoidance of long-term anticoagulation (use of blood thinners), and better preservation of native heart function.
Various techniques are employed to achieve successful mitral valve repair. Reconstruction of the valve leaflets may be required along with reinforcement of the annulus of the valve with a special ring called an annuloplasty ring.
Annuloplasty describes surgical techniques performed on the valve's annulus, the ring of tissue that supports the valve leaflets. Purse-string sutures are sewn around the ring to make the opening smaller which helps the leaflets meet again when the valve closes. Sometimes when repairing the annulus (the frame of the valve) it is necessary to implant an annuloplasty ring to downsize an abnormally enlarged valve opening so the leaflets can come together properly or to provide reinforcement of the annulus. Annuloplasty rings are specially designed to help restore the annulus of the valve to its normal shape and size.
Clear advantages of mitral valve repair versus replacement include:
- A lower mortality at the time of operation (1-2% for mitral valve repair versus 6-8% for replacement)
- A significantly lower risk of stroke, and a lower rate of infection
- Improved long-term survival with mitral valve repair
- Patients who receive a mitral valve repair stay on the same survival curve as the normal population
- After mitral valve repair, blood thinners are not required, in contrast to the life-long requirement for blood thinners after mechanical mitral valve replacement
Heart Valve Replacement
If the diseased native heart valve cannot be repaired, the surgeon may choose to replace it. Heart valve replacement surgery involves removing the diseased valve and replacing it with a prosthetic valve by sewing it to the annulus of the natural valve. Prosthetic valves come in different sizes to fit the patient and are made from a variety of materials. Approximately 95 percent of all valve replacements are performed for aortic or mitral valves.
There are two main types of prosthetic heart valves. Tissue (bioprosthetic) valves are made primarily from animal tissue, for example, a pig's aortic (porcine) valve or from bovine pericardium. Mechanical valves are created from man-made materials.
Choosing the right treatment option is a decision that should be made in close cooperation with a doctor. Factors that need to be considered when choosing a treatment option include age, risks and benefits of each type of treatment, current medications, other medical conditions, and lifestyle.
Ask your doctor about heart valve repair or replacement surgery. Both procedures are commonly used and highly effective in treating heart valve conditions. You may even be able to stop taking certain medications after surgery.
