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Question:

Are there minimally invasive techniques for repairing a mitral valve?

My mother is 82 years old, has severe mitral valve regurgitation, but very few symptoms. Her TEE and regular echoes show that one of the mitral valve leaflets is torn and "flailing". Her cardiologist was hoping she could avoid surgery, but her last two echoes show that her pumping function is beginning to decline after being stable for almost two years. She has had a pacemaker for 15 years and is essentially asymptomatic, but feeling more tired lately. He is now recommending surgical repair of the mitral valve. She has no other major health issues. Are there minimally invasive techniques that can repair a leaflet that is torn or is this always a surgical, open heart procedure?

submitted by Erica from Houston, Texas on 11/13/2012

Answer:

James J. Livesay, MDby Texas Heart Institute cardiovascular surgeon, James J. Livesay, MD  

Dear Erica, Unfortunately, there are not any effective, non-invasive ways to repair the mitral valve. Open heart surgery for repair of the mitral valve is recommended in most patients with mitral regurgitation (leakage) because it leads to heart failure and atrial fibrillation which can cause stroke. Today most forms of mitral regurgitation can be repaired through open heart surgery. The risk of repair is less than the risk of valve replacement in most mitral conditions. Although age over 80 increases the surgical risk  and certainly prolongs the recovery (2 or more months), a satisfactory repair will relieve symptoms and prevent mortality.  Most heart procedures are done through the sternum although some mitral procedures are done through a smaller “minimally invasive” incision in the right chest. Studies have shown this approach does not reduce complications and has little advantage other than cosmetics. It may increase the risk of stroke especially in older patients and requires a longer time on the pump (also a concern in older patients). Mitral valve repair is associated with a risk of mortality less than 1% nationally; the risk in someone over 80 is probably 2-5 % depending on the patient’s other comorbidity (health concerns). I would recommend that your mother see a surgeon who specializes in mitral valve repair as this will give you the best chance for repair with all pathologic conditions (90% of degenerative mitral valve disorders are believed repairable).

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Updated November 2012
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