Treating Mitral Valve Disease

The Structural Heart and Valve Disease team treats many patients with mitral valve disease. They have years of experience and are able to offer multiple therapies and procedures, including: 

The Structural Heart and Valve Disease team will talk with you about these treatment options to determine the best approach for your specific needs.

Transcatheter Mitral Valve Repair (MitraClip)

If you have significant mitral valve regurgitation, but you cannot have surgery, your heart team may consider transcatheter mitral valve repair using MitraClip. This therapy to repair the valve has been shown to improve symptoms and decrease hospital stays.

Your physician will use 3D imaging to analyze and evaluate the mitral valve in very fine detail before, during and after the procedure.

Three-dimensional evaluation of mitral valve (A), followed by clip above valve (B), and then clip placed through valve (C).

Your doctor will make a small incision in your groin and thread a tiny catheter through a vein to your heart. This catheter is used to deliver the MitraClip, which is a small device that clips the leaflets together to reduce the backward flow of blood.

Echocardiogram showing pre-procedural mitral regurgitation (top row) and then after Mitraclip procedure (bottom row). Notice the decrease in color due to a decrease in mitral regurgitation.

Following the procedure, you will stay overnight in the hospital for a couple of days for monitoring and then recover at home.

The U.S. Food and Drug Administration (FDA) approved MitraClip therapy for patients who have severe, degenerative mitral valve regurgitation, but cannot have open-heart surgery. However, Swedish is participating in an important research study that allows patients with a different type of mitral valve regurgitation — functional mitral valve regurgitation, an abnormality of the left ventricle that causes the leaflets (flaps) of an otherwise normal mitral valve to close improperly — to be considered for MitraClip valve repair therapy. More information about this study is available on this page. 

Transcatheter mitral valve replacement (NEW section)

Swedish has been selected for a new research study for transcatheter mitral valve replacement. More information about the TMVR trial is available on this page

Transcatheter Mitral Valve-in-Valve Replacement

Transcatheter mitral valve-in-valve replacement is a therapy for patients who have had a previous valve replacement procedure using a bioprosthetic valve, but the valve is no longer working properly. Bioprosthetic valves are made from animal valves or tissue, and usually last 10-20 years. That is why younger patients who have had a mitral valve replacement using a bioprosthetic valve may need to have it replaced at some point. The new valve is implanted through a catheter that the doctor threads through a small incision in the groin and into the heart. Once the doctor sees that it is positioned correctly, a small balloon inflates to push the valve open. As soon as the new valve is open, it takes over responsibility for controlling the blood flow from the left atrium to the left ventricle. Depending on the mitral valve, this may be done with general anesthesia or conscious sedation.

Transcatheter Balloon Mitral Valvuloplasty

Balloon mitral valvuloplasty is a procedure to widen the opening in a valve that has narrowed due to mitral valve stenosis. Typically it is a procedure that is used in place of valve replacement in children, teens and young adults who have congenital stenosis. It may also be used as a “bridge” for older adults who are too sick to have a valve replacement procedure right away. In older adults who have had balloon valvuloplasty the stenosis may return, which would then require a valve replacement procedure.

You may be awake during the procedure, but your anesthesiologist will administer local anesthesia and other pain medicine to minimize pain and ensure you are relaxed. Your cardiologist will insert a catheter through a very small incision in your groin, and then thread it through the artery into your heart and valve. After ensuring proper placement, your cardiologist inflates the balloon at the end of the catheter. Patients who have transcatheter balloon mitral valvuloplasty usually stay overnight in the hospital following their procedure.

Open Repair or Replacement Surgery

Open-heart surgery is the most common treatment to repair or replace a damaged mitral valve in young and healthy adults. You will be under general anesthesia. Your heart surgeon will make a long incision (six to eight inches) in your chest and through your breast bone to allow access to the heart. Throughout the entire procedure your blood will circulate through a cardiopulmonary bypass (heart-lung) machine (keeps blood circulating through your body, but diverts it around the valve that is being replaced. The pump is often called a heart-lung machine.) If your valve is very damaged, your surgeon will replace it with a mechanical valve (an artificial valve used to replace a damaged heart valve, usually made out of titanium or carbon) or a bioprosthetic valve (an artificial heart valve made out of animal tissue, usually from a pig), rather than trying to repair it. 

Open mitral valve replacement surgery

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Open mitral valve repair surgery

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After surgery, you will recover in the hospital for a few days and then at home for several weeks or possibly a couple of months.

Some heart surgeons may choose to repair or replace a mitral valve using a procedure called a mini-sternotomy. It is similar to open-heart surgery, except the heart surgeon makes only a four- or five-inch incision in the upper part of the chest and only spreads the upper portion of the breast bone. Another surgical option is a mini-thoracotomy, which doesn’t require cutting through the breast bone. Instead, the surgeon makes a two-to-three inch incision and uses special instruments to access the heart through the ribs.

Elderly individuals and those who are very frail or have multiple medical conditions may not be eligible for open-heart surgery.

For more information about open-heart mitral valve surgery, go to Swedish Cardiac Surgery 

Minimally Invasive Mitral Valve Repair or Replacement

Heart surgeons at Swedish are able to repair or replace mitral valves using a minimally invasive approach. Minimally invasive surgery is performed through very small incisions to reduce the trauma to the body. Your surgeon will make a small incision in the center or side of your chest. With a minimally invasive approach, you will have a shorter hospital stay and quicker recovery time than with open-heart surgery. 

Surveillance and Medical Management

Mitral valve stenosis and mitral valve regurgitation can develop over time. Therefore, you may have mild or no symptoms at all. At first, your doctor may want to monitor your condition during regular visits and may prescribe medicine to help control your symptoms. For example, you may take medicine to reduce fluid build-up, lower your blood pressure, slow your heart rate or control your heart’s rhythm. Your doctor may order repeat echocardiograms to track the progress of your mitral valve disease. Eventually, as your symptoms worsen and they begin to affect your quality of life, your doctor may recommend a procedure or surgery to repair or replace the damaged valve.

For more information about minimally invasive surgery for mitral valve repair or replacement, go to Swedish Cardiac Surgery