The preferred treatment for patients with mitral valve disease is mitral valve 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 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, long-term blood thinners are not required, in contrast to the life-long requirement for blood thinners after mechanical mitral valve replacement