Our Mitral Valve Program
Our multidisciplinary cardiovascular team collaborates on mitral valve repair, transcatheter technologies, mitral valve replacement, and follow-up treatment so patients can get all their care for mitral valve leaks in one place.
As part of an academic medical center, University of Utah Health physicians and surgeons are on the leading edge of research and the latest innovations in cardiac care and clinical therapies for heart valve repair. U of U Health is the first center in the Mountain West to use robotics for minimally invasive heart surgery.
We use a whole-patient approach to do what is best for each individual based on available treatments and the patient’s heart condition(s), diagnosis, and events.
Types of Mitral Valve Surgery
Most patients who have mitral valve leaks are candidates for mitral valve repair or replacement surgery. The options are:
- Full sternotomy — The surgeon will make an eight- to 10-inch incision down the center of your chest, then cut through the sternum to access your heart. Full recovery from this open-heart procedure can take several months.
Minimally Invasive Procedures
- Transcatheter mitral valve repair — The surgeon will place a MitraClip® through a thin tube (catheter) inserted into a vein in your groin area (femoral vein). This procedure is approved for high-risk patients who cannot get traditional surgery and failed optimization with medical management.
- Transcatheter mitral valve replacement — This has only been done on a small group of patients using a valve that was designed for aortic valve replacements. It is not approved for most patients. These procedures come with high risks and a person must have a very specific anatomy for them to succeed. Clinical trials are currently underway to test the effectiveness of mitral valve replacements using transcatheter replacement.
- Partial sternotomy — An open-heart procedure with a smaller incision of three to four inches in the upper part of the sternum to access the mitral valve. This technique will not damage your sternum as much.
- Right Thoracotomy — The surgeon will make several small incisions (about one inch each) in the chest by your ribcage. They will insert robotic instruments to perform the surgery. This will allow the surgeon to repair your mitral valve without open-heart surgery.
Mitral Valve Repair vs. Replacement
Our team will often recommend mitral valve repair over replacement for the following reasons:
- Has lower death rates than mitral valve replacement
- Causes fewer strokes
- More effectively reduces leaking
- Does not require you to take blood thinner medication
- Has a shorter recovery time
- Leads to fewer long-term heart rhythm problems
Preparing for Surgery
Before scheduling your surgery, you will meet with a cardiologist and cardiothoracic surgeon. They will order an echocardiogram or angiogram (heart imaging tests) to determine:
- the cause of your mitral valve leak,
- whether you need mitral valve repair or replacement, and
- what type of procedure will give you the best outcome.
Your heart team will provide the following instructions on how to prepare:
- stop eating and drinking at least 8 hours prior to the procedure,
- shower with Hibiclens soap,
- the time to arrive at the hospital (usually in the morning, but the exact time will depend on your schedule), and
- types of items to pack for your stay (think packing for a one or two-night stay at a hotel).
At the time of surgery, you will be put to sleep under general anesthesia and remain on a heart-lung machine throughout the procedure. The surgery typically takes five to six hours.
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Mitral Valve Repair Surgery Techniques
The techniques used to repair a mitral valve depend on your diagnosis. We may also use robotic instruments for minimally invasive mitral valve procedures.
The surgery for repair may involve a combination of various techniques:
- Cutting a redundant valve tissue
- Using a stitch to support the prolapsed leaflet
- Suturing two leaflets to one another
- Putting a plastic ring around the valve to prevent further failure
In some cases, a patient’s mitral valve will not allow blood to flow through properly because the leaflets stick together and don’t open all the way. We may use a balloon valvuloplasty for this type of mitral valve issue. During the valvuloplasty procedure, your surgeon will insert a small device that is inflated to “balloon” the valve and pull the leaflets apart.
Mitral Valve Repair Recovery
After surgery, you will go directly to ICU. You will remain at the hospital as an inpatient for five to seven days (some patients may need to stay longer) while you recover.
After you are discharged from the hospital, you will need to rest and recover for three to four weeks at home. Your doctors will provide information on how much activity you can do, and when, to ensure a successful recovery. You will need someone to drive you home from the hospital.
Transcatheter Edge-to-Edge Repair (TEER) with MitraClip® & PASCAL
Transcatheter mitral valve repair is minimally invasive but comes with limitations on what surgeons or interventional cardiologists can do. There are two devides with FDA-approved TEER guidance: MitraClip®(mitral valve clip) and PASCAL. TEER is for high-risk patients who are not candidates for open heart surgery. In most cases, this procedure will not stop a leak entirely, but it can reduce the leak and improve your symptoms.
Mitral Valve Clip Procedure
During the procedure, your surgeon and cardiologist will place a catheter (small tube) in your femoral vein in the groin area. Using a guide wire, he or she will move the catheter to your left atrium (heart chamber that pumps blood to other areas of the heart), then put the MitraClip® through the catheter. Once inside your heart, your surgeon will put the clip in the leaflet of the mitral valve to reduce the leak. In some cases, the surgeon may need to insert more than one clip.
Mitral Valve Clip Recovery
This procedure lasts about two to three hours, depending on a patient’s anatomy. Afterward, you will spend about an hour in a recovery room, then move to a room where you will stay for one night (some people may need to stay longer). Most patients will typically go home the following day. This procedure has a quicker recovery time than open-heart surgery. However, it may still take several weeks to make a full recovery.
Mitral Valve Clip Success Rate
Studies have shown that the MitraClip® success rate is between 80 and 90 percent, and there is no difference in mortality (death) versus a traditional heart surgery to repair the mitral valve. Many patients feel better after this procedure and experience fewer symptoms. Most patients who get MitraClip® will not need any additional surgeries later.
Mitral Valve Replacement
Your doctors will determine whether you are a good candidate for repair, and if not, will discuss the options for mitral valve replacement. For some patients, the mitral valve cannot be repaired and the only option is to replace it. In other cases, your surgeon may attempt a repair first, then perform a mitral valve replacement at a later time if the repair fails.
Mitral valve replacement surgery involves removing the failing valve, then putting in a new one made of synthetic materials (such as titanium or cobalt) or biological materials (such as animal or human tissues). However, an artificial valve may come with complications, including:
- shorter 10-year survival rates compared to mitral valve repair,
- need to stay on blood thinner medication for several months or even for the rest of your life based on the type of valve, and
- valve degeneration for tissue valve needing repeat intervention.
Recovering from Mitral Valve Replacement Surgery
You will spend five to seven nights in the hospital following your surgery. After discharge, you will need to rest and recover for three to four weeks at home. Your doctor will talk to you about how to slowly increase your activity for a safe and successful recovery. You will need someone to drive you home from the hospital.
You will be on a blood thinner medication (warfarin) for at least several months following your surgery. Some patients will need to take a blood thinner for the rest of their life.
How Long Does a Mitral Valve Replacement Last?
The success rate for replacement surgery is good and has very few risks. The most common risks of this surgery include:
- bleeding,
- infection,
- stroke, or
- death (very rare).
Your body will not usually reject the valve, but over time the valve can wear out. Biologic valves made of human or animal tissue only last for about 10 to 15 years. Synthetic valves can last longer, but have higher risks of blood clotting.
How to Make an Appointment
Patients who would like to see providers in our Mitral Valve Program can contact the Valve Clinic at 801-585‑7676. You will speak to a coordinator who will schedule an initial appointment for you. A referral is not required to be seen in our Valve Clinic. However, you can get a referral to see our doctors from your primary care physician or another doctor.
Insurance Coverage
Some insurance plans do require a referral from your primary care provider to see a specialist. If your plan requires it, make sure you get a referral so your care will be covered under your plan. Contact your insurance carrier for questions about referral requirements or coverage.
A mitral valve repair or mitral valve replacement surgery usually requires pre-authorization from your insurance carrier. Most insurance plans will cover these surgeries once we obtain pre-authorization.
Hear From Our Patients
Greg Denning has never really liked going to the doctor, and for most of his life he’s been an active person who was able to avoid significant medical care. That started to change one day when he was building a cabin in Wyoming. He started experiencing physical symptoms, like shortness of breath and fatigue, that made his wife worry, especially as his symptoms worsened over time. Then, during a routine physical,
Greg’s primary care doctor noticed signs of a heart problem and immediately sent him to a cardiologist. He was eventually diagnosed with a severe mitral valve leak that would require heart surgery.