Mitral Valve Repair

Why is Mitral Valve Repair Necessary?

The mitral valve is one of four valves in the heart, and ensures that blood returning from the lungs flows forward from the left atrium and into the powerful left ventricle, where it is pumped to the rest of the body.  There are three main problems that can occur with the mitral valve.  In mitral stenosis, the opening of the valve becomes narrowed.  In mitral regurgitation, the valve does not close properly, and blood flows backward when the valve should be tightly closed.  In mitral valve prolapse, the valve does not close properly, and part of the valve bulges back into the left atrium. 

 

If the mitral valve is not functioning, blood does not flow properly through the heart.  As a result, the heart has to work harder, and the structure of the heart becomes altered.  These changes eventually lead to symptoms in the patient, including shortness of breath and fatigue with exercise.  Over time, there may be irreversible changes that prevent the heart from pumping properly.  Experts now recommend earlier surgery for mitral valve disease to prevent these irreversible changes. Traditionally, surgeons would perform mitral valve replacement, where the diseased valve is removed and replaced with an artificial valve.  Now, experts generally agree that whenever possible, a heart valve should be repaired.

Why Mitral Valve Repair instead of Mitral Valve Replacement?

The goal of mitral valve repair is to restore function to the patient’s own valve.  The main advantages are a long term solution to restoring function and the potential for less complications. 

Mitral valve repair has been proven in multiple studies to be superior to valve replacement in terms of surgical mortality, long term durability of repair (which means a longer time before another operation might be needed), valve function and long-term survival.  Mitral valve repair provides excellent long term results without the need for a second operation that may be needed when the valve is replaced. 

For example, 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 important consideration is that mitral valve repair does not require blood thinners (known as "coumadin" or "warfarin") to be taken after the operation.  Blood thinners increase the risk of bleeding, and may lead to stroke or other medical problems.  In addition, blood thinners can not be used in women who may become pregnant as they cause severe damage to an unborn child. 

 

The 2006 guidelines from the American Heart Association and the American College of Cardiology state that “mitral valve repair is recommended over mitral valve replacement in the majority of patients with severe chronic mitral regurgitation who require surgery, and patients should be referred to surgical centers experienced in mitral valve repair.”  Despite this recommendation, a study by the Society of Thoracic Surgeons revealed that only 50% of isolated mitral valve surgeries are repairs. 

 

For our surgeons, mitral valve repairs are completed in 90 to 95% of patients with degenerative mitral valve disease (the most common type of mitral valve disease).  As noted by Dr. Aidan Raney:

 

"Mitral valve repair surgery offers substantial advantages over replacement since it leaves a patient's own living tissue functioning normally.  Repair gives patients an 80 percent chance that they may go the rest of their life without any further surgery on that valve, and it eliminates the need for the medication therapy associated with traditional valve replacement surgery."

Why Choose Our Surgeons for Mitral Valve Repair?

As stated in the paragraph above, the American Heart Association recommends that patients receiving mitral valve repairs “should be referred to surgical centers experienced in mitral valve repair.”  Some surgeons only perform mitral valve repair on a small number of patients.  The heart surgeons at Raney Zusman Medical Group repair more heart valves than any other medical center in Orange County, and this high volume of repair gives our surgeons expertise in mitral repair.  Our surgeons also perform minimally invasive surgery techniques that minimize pain and recovery from surgery, including robotic mitral valve repair.

Expertise in Mitral Valve Repair

Excellent results in surgical care are built on a good foundation of surgical skill followed by a large number of cases to reinforce these skills. The surgeons at Raney Zusman Medical Group have completed top-notch residency training in cardiovascular surgery at Stanford University (Dr.'s Raney and Zusman) and UCSD (Dr. Joyo) medical centers.

 

Our surgeons have been performing complex mitral valve repairs since the early 1990’s.  To learn the techniques, our surgeons traveled to France to study with the founding pioneer of mitral valve repair surgery, Dr. Alain Carpentier.  They also studied under Dr. Carlos Duran, another pioneer in mitral valve repair from the north of Spain.  The accomplishments of Dr. Raney, Dr. Zusman, and Dr. Joyo were recently honored as Dr. Carpentier returned to the United States to speak at the opening of the Hoag Heart Valve Center.  Dr. Carpentier and Dr. Duran have also returned to lecture at the International Valve Symposium, which is hosted in Newport Beach by the Hoag Hospital and the surgeons of Raney Zusman Medical Group.

 

In addition to superior training, our surgeons have performed a large volume of mitral valve repairs, averaging 80 to 100 cases annually.  Every mitral valve repair poses a unique challenge, and this experience allows our surgeons to correctly assess the mitral valve and plan an effective surgery to eliminate the problems with valve function.

 

Echocardiography Teamwork at Hoag Hospital

Our surgeons have a unique advantage in mitral valve repair in their teamwork with Dr. Pravin Shah, an internationally renowned pioneer of echocardiography and Master of the American College of Cardiology.  Under this arrangement, Dr. Shah performs echocardiography (which is an ultrasound of the patient's heart) on the patient before, during, and after mitral valve repair surgery. 

 

The pre-operative echocardiogram provides the surgeon with an understanding of the problem from a functional view, which essentially gives information about what is wrong when the heart is actually working. The surgeon can then tailor his operative approach to ensure that this problem is fixed.

 

Once the repair is complete, Dr. Shah will again assess the function of the valve by echocardiography before the sternum is closed.  This allows Dr. Shah and our surgeons to assess the function of the heart when it is actually beating and filled with blood.  At this point, 95% of the valves are fully repaired, and the echo-surgery team is assured that the repair is successful before closing the heart.  A small number of patients may show abnormal blood flow through the valve.  In these patients, our surgeons can revise the initial repair and ensure success before the patient leaves the operating room.  In a recent presentation in Barcelona, Spain, Dr. Shah, Dr. Aidan A. Raney, and Dr. Aidan R. Raney (son of Dr. Raney) reported that of 207 mitral valve repairs between 2000 and 2005, 203 patients had successful repair or revision of initial repair, with only mild regurgitation from the valve after surgery.  Overall, the echo-surgery teamwork between our surgeons and Dr. Pravin Shah is a key component of our better outcomes, and contributes to our increased survival rates.

Excellent Results

Dr. Aidan Raney and Dr. Pravin Shah recently published a paper in the Journal of Heart Valve Disease, demonstrating better outcomes with echo-surgery teamwork. As stated in the paper: "Mitral Valve repair was successful in 67 of 68 (98.5%).  Repair was unsuccessful in only one patient, who received a successful mitral valve replacement."

 

Internationally Renowned Surgeons

The surgeons of Raney Zusman Medical Group have completed trips to India, Paris, Thailand and London to give lectures on mitral valve repair. They have also completed multiple scientific papers on mitral valve repair, including a recent presentation in Barcelona.  Hoag Hospital and the surgeons of Raney Zusman host the bi-annual International Valve Symposium in Newport Beach, CA.  Our surgeons have also received numerous awards, which can be seen in our awards and outcomes section.

(Pictured at left are Dr. Raney and Sir Magdi Yacoub from the 2005 International Valve Symposium). 

 

More Information on Mitral Valve Repair Surgery

If you have questions about the specifics of mitral valve repair or would like to know if you are a candidate for mitral valve repair surgery, please contact us or call (949) 650-3350 to schedule a consultation. 

 

Please see our section on mitral valve surgery for more information about preparing for mitral valve surgery, what to expect during surgery, and recovery from mitral valve repair surgery.