Mitral Regurgitation Repair By Minimally Invasive Surgery

If You’ve Just Been Told Your Mitral Valve Is Leaking

You have probably been told three things: that you have mitral regurgitation, that it may need surgery one day, and that you will be monitored. What you may not have been told is that the type of operation, and when it happens, changes your outcome more than almost anything else.

Most leaky mitral valves can be repaired rather than replaced. Repair keeps your own valve, avoids lifelong blood thinners in most cases, and gives the best long-term result. And in experienced hands, repair does not require the breastbone to be cut.

This page explains what a leaky valve is, how we decide between repair and replacement, why we operate through the side of the chest, rather than break the breastbone.

What Mitral Regurgitation Actually Is

The mitral valve sits between the two chambers on the left side of your heart. It should open to let blood through and shut tight when the heart squeezes. In mitral regurgitation it doesn’t shut tight, so with every beat some blood leaks backwards into the upper chamber instead of going forward to the body.

A small leak is common and often harmless. A significant leak makes the heart work harder with every beat. Over months and years that stretches the heart, triggers atrial fibrillation, and raises pressure in the lungs. By the time you feel breathless, some of that change may already be permanent.

There are two types, and the distinction matters for treatment:

• Primary (degenerative): the valve itself is the problem, usually a floppy leaflet or a snapped cord. This is the type I repair most often, and repair rates in my hands are very high.
• Secondary (functional): the valve is structurally normal but the heart around it has stretched, typically after a heart attack or from cardiomyopathy. Treatment here is more individual and starts with the underlying heart muscle.

If you have an echo report, look for the words “prolapse”, “flail” or “degenerative”. Those usually mean a repairable valve.

Symptoms of Mitral Regurgitation

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Symptoms. Often none for years. When they come: breathlessness on exertion or lying flat, tiredness out of proportion to effort, palpitations or a new irregular heartbeat, swollen ankles, a murmur your GP has heard. Sudden severe breathlessness can mean a cord has snapped and needs urgent assessment.

Causes. Mitral valve prolapse and ruptured cords (the common, repairable ones); rheumatic disease from childhood infection; endocarditis; a previous heart attack; cardiomyopathy; long-standing atrial fibrillation; rarely, a valve you were born with.

Complications of leaving it. Atrial fibrillation and stroke risk, heart failure, pulmonary hypertension. All three make later surgery riskier and the result less complete, which is why I favour early repair when the leak is severe.

Mitral Regurgitation Valve Causes

Your heart has four valves that keep the blood flowing consistently in the correct direction. These are the mitral valve, tricuspid valve, aortic valve, and pulmonary valve. Each of these valves has flaps, otherwise known as leaflets or cusps, that open and close once during each heartbeat. If they don’t open or close properly, the blood flow can be disrupted.

The most common causes of mitral valve regurgitation include:

• Mitral valve prolapse – a common heart issue where the mitral leaflets bulge back into the left atrium during contractions, preventing the valve from closing tightly.
• Damaged tissue cords – heart tissue cords that anchor the leaflets to the heart muscle may stretch or tear, causing a mitral valve leak.
• Rheumatic fever – a complication of untreated strep-throat infection in early life that could damage the mitral valve, causing regurgitation later in life. When mitral valve damage results from rheumatic fever, it’s called rheumatic heart disease.
• Heart attack – this can damage the area of the muscle that supports the valve, affecting its function.
• Congenital heart defects – it is possible to be born with damaged heart valves.
• Endocarditis – the valve may be damaged by an infection of the lining of the heart.
• Atrial fibrillation – atrial fibrillation is a common heart rhythm problem that can be a potential cause of mitral or tricuspid valve regurgitation.
• Cardiomyopathy – when the heart muscle becomes abnormally thick (hypertrophic cardiomyopathy) or stretched and weakened (dilated cardiomyopathy), the heart may struggle to pump blood efficiently.

Potential Mitral Regurgitation Complications

When it is mild, mitral valve regurgitation usually does not cause any problems. However, severe mitral valve regurgitation can lead to complications, including:

• Atrial fibrillation: While atrial fibrillation is a cause of regurgitation, it can also be a future complication. The stretching and enlargement of the left atrium may lead to this heart rhythm irregularity, causing blood clots that can travel to other parts of the body. In the brain, this will lead to a stroke.
• Heart failure: Congestive heart failure can happen when your heart can’t pump enough blood to meet your body’s needs. Severe mitral valve regurgitation places more strain on your heart, and if the left ventricle continues to stretch without treatment, the heart could fail.
• Pulmonary hypertension: if you have untreated regurgitation, you could develop high blood pressure that affects the lung vessels. A mitral valve leak can increase pressure in the left atrium, which can eventually lead to pulmonary hypertension.

Diagnosis of Mitral Regurgitation

Diagnosing mitral valve regurgitation typically involves a few steps.

1. First, your doctor will talk to you about your symptoms and medical history, and listen to your heart. A heart murmur (an abnormal whooshing sound) heard through a stethoscope can be an initial clue.
2. The key test for confirming a leaky mitral valve is an echocardiogram – an ultrasound of the heart. An echo shows the mitral valve in motion and measures how much blood is leaking backwards, while also checking if the heart chambers are enlarged or under strain.
3. Your doctor might also order other tests to get a complete picture, such as an electrocardiogram (ECG) to check your heart rhythm, a chest X-ray to see if the heart is enlarged or if there is fluid in the lungs, or a cardiac catheterisation (angiogram) to examine the coronary arteries and heart pressures (especially if surgery is planned).
4. If there is any doubt regarding the severity of the leak, then a test such as stress echocardiography (either medically induced or during mild exercise) is very valuable.

Early surgery should certainly be performed if repair of the valve is possible, since this is far superior to replacement. If the valve is not repairable, then replacement should be considered when symptoms develop, or if there is evidence of heart enlargement, atrial fibrillation, or pulmonary hypertension.

At The Keyhole Heart Clinic, we provide comprehensive heart evaluations using the latest technology. Once we confirm a mitral valve regurgitation diagnosis, we’ll explain how severe it is and discuss what that means for your treatment plan.

Repair or Replace, and When: The Two Decisions That Shape The Rest of Your Life

Repair beats replacement. A repaired valve is your own tissue. It lasts, it does not need lifelong warfarin, and it carries a lower long-term risk than a replacement. International guidelines say a severe degenerative leak should be repaired in a centre where repair is the expected outcome, not the hoped-for one. Ask any surgeon you see one question: what proportion of your mitral valves do you repair rather than replace?

Earlier beats later. Severe regurgitation should be treated before the heart shows strain, even if you feel well. Waiting for symptoms means waiting for damage. In a patient with a severe, repairable leak I would rather operate this year than monitor for three and operate on a bigger, weaker heart.

What I’ll tell you at your consultation:

1. Whether your leak is mild, moderate or severe, on your own images, in plain language.
2. Whether I expect to repair it, and my honest estimate of the chance.
3. Whether it should be done now, or safely watched, and what I would look for on the next scan.
4. Whether keyhole is right for you. It is for most people with isolated mitral disease.

You leave knowing what you are dealing with and what your options are. There is no obligation to have surgery with me. My team and I want you to get as much value from your consultation with me. If you do decide to proceed with surgery then our 9 step system will ensure that we can give you best treatment available today.

Keyhole Mitral Repair Versus Opening The Chest

Traditional mitral surgery splits the breastbone from top to bottom. It works, but the bone takes three months to heal and that dominates your recovery. Keyhole surgery reaches the same valve through a 5cm incision between the ribs on the right side. The operation on the valve is identical. What changes is what your body has to recover from.

The last row is the one that matters. Keyhole is not a compromise on the repair. Randomised trials comparing minimally invasive and conventional mitral surgery show equivalent safety and repair quality with shorter recovery. I have been doing this operation this way since the early 2000s and I do not offer patients a sternotomy for isolated mitral disease unless there is a specific reason.

Who it suits: almost everyone with isolated mitral regurgitation, including patients in their 70s and 80s, patients with atrial fibrillation (which I can treat at the same time), and patients who have been told elsewhere they need their chest opened.

Who it may not suit: patients who also need multi-vessel bypass grafting, severe lung disease on the right side, or certain previous chest operations. I’ll tell you honestly at consultation.

More About Mitral Valve Regurgitation Treatment

Treatment for mitral valve regurgitation depends on risk factors, the severity of the leak and how it’s affecting your health. Our priority is to manage the condition in the least invasive way that still protects your heart.

Monitoring & Medications

Heart problems present differently throughout the course of your life. If you have a mild, leaky mitral valve and you’re not experiencing symptoms, we may recommend regular monitoring rather than immediate intervention. This watchful waiting approach helps us track your heart health over time and detect any changes early.

We’ll schedule periodic echocardiograms to assess how well your valve is functioning and how your heart is coping.

Medications may be used to manage related issues and improve your quality of life. These might include:

• Blood pressure medications such as beta-blockers, angiotensin-converting enzyme (ACE) inhibitors (relax blood vessels) and calcium channel blockers (improve blood flow)
• Diuretics to relieve fluid buildup in the lungs
• Drugs to manage irregular heart rhythms, such as atrial fibrillation
• Blood thinners to help prevent blood clots, particularly if abnormal heart rhythms are present

These medicines won’t cure the leaky valve, but they can improve how you feel and help prevent complications while we keep a close eye on your condition.

Mitral Valve Repair or Replacement

If the leak is severe or you’re experiencing significant symptoms, fixing the valve is usually the best course of action. Intervening at the right time can prevent long-term damage to your heart and improve your quality of life.

Whenever possible, a mitral valve repair is the preferred surgical solution. Repair means the surgeon mends your existing mitral valve opens and closes properly. This preserves your natural valve and usually provides the best long-term outcome, often without the need for lifelong medications.

If the valve is too damaged to repair, a mitral valve replacement will be performed. In a replacement, the faulty valve is removed and a new artificial valve is implanted. If a repair isn’t possible, the valve will be replaced with an artificial valve (mechanical or tissue).

We will discuss which option is most suitable for you based on your age, health, and personal preferences, and make sure you understand the benefits and considerations of each.

Minimally Invasive (Keyhole) Heart Valve Surgery

At The Keyhole Heart Clinic, mitral valve replacement or repair can often be done with a minimally invasive keyhole approach instead of traditional open-heart surgery.

Keyhole surgery is performed through a small incision on the right side of your chest, between the ribs, avoiding the need to cut through the breastbone. For you, this means a smaller scar, less pain, and a faster recovery compared to the conventional approach.

Most patients with mitral valve regurgitation are candidates for this less invasive method, and our surgical team will confirm if it’s appropriate for you. We have extensive experience in keyhole heart surgery and strongly recommend this approach when feasible due to its many patient benefits.

Benefits of Keyhole Mitral Valve Surgery

When surgery is required, opting for a keyhole heart surgery technique (minimally invasive mitral valve surgery) offers many advantages for patients.

The benefits of keyhole mitral valve surgery include:

• Small incision, minimal scarring: The procedure is done through a small side incision without breaking the breastbone. You avoid the long chest scar from open-heart surgery, resulting in a much smaller, less visible scar.
• Less pain and faster healing: With no bone cutting, post-operative pain is significantly reduced. Patients are typically more comfortable moving around soon after surgery and heal faster. You can return to daily activities much sooner than with the traditional approach.
• Faster recovery: Patients are often home from the hospital within a week, and you can return to work, exercise, and daily routines much sooner than after open-heart surgery. Plus, because your breastbone isn’t cut, you don’t face the 2–3 month lifting restrictions that come with traditional surgery.

Our team at The Keyhole Heart Clinic has pioneered minimally invasive cardiac surgery techniques. We will evaluate your case to ensure that a keyhole approach is appropriate for you. For the vast majority of people with isolated mitral valve regurgitation, we believe this technique offers an excellent outcome.

Recovery After Keyhole Mitral Valve Surgery

After undergoing keyhole mitral valve surgery, most patients stay in the hospital for about 4–7 days. By discharge, you can walk and care for yourself.

Once home, you may feel tired for a couple of weeks, but you will notice improvement each day. Because no breastbone was cut, you can move around freely and do light activities as soon as you feel up to it, without the usual post-surgery lifting restrictions. Within about 4–6 weeks, many patients return to office work and normal routines.

We will see you for a follow-up appointment a few weeks after surgery to check your incision and perform an echocardiogram, ensuring the valve repair is working well. We may also recommend a gentle cardiac rehabilitation program to help you regain strength safely.

Compared to traditional open-heart surgery (where recovery can take 2–3 months due to bone healing), the minimally invasive approach allows you to get back to your life much sooner.

Transcatheter Mitral Repair (MitraClip)

For patients too high-risk for surgery, a catheter-based procedure can sometimes be used to clip the mitral valve and reduce the leak. This minimally invasive treatment, via a vein in the groin, may improve symptoms in those who cannot undergo an operation.

Help your family and friends better understand mitral valve regurgitation causes and treatment with our easy-to-follow video library. You should focus on feeling supported, not explaining.

FAQs on Mitral Regurgitation

Do I need surgery if my mitral regurgitation is severe but I have no symptoms?

Usually yes, if the valve is repairable. Current guidelines support early repair of severe degenerative regurgitation in an experienced centre before the heart enlarges, because waiting for symptoms means waiting for damage. I would review your echo and give you a specific answer.

Can a leaky mitral valve be repaired rather than replaced?

In most cases of degenerative (primary) regurgitation, yes. In my practice the great majority of these valves are repaired. Repair preserves your own valve, usually avoids lifelong anticoagulation, and has better long-term outcomes than replacement.

Is keyhole mitral valve surgery as safe as open-heart surgery?

Yes. Randomised trials and large registries show minimally invasive mitral surgery has equivalent safety and repair quality to sternotomy, with less pain, shorter hospital stay and faster recovery. The operation on the valve is the same; only the way in differs.

How long is recovery after keyhole mitral valve repair?

Most of my patients go home 4-7 days after surgery, drive at around two weeks, and return to office work within four to six weeks. Because the breastbone is not cut there are no lifting restrictions, and exercise can restart as soon as you feel able.

Will I be able to have keyhole surgery if I’m over 75?

Usually. Age alone is not a barrier and older patients often benefit most from avoiding a breastbone cut. What matters is your overall fitness, lung function and whether you need other procedures at the same time.

Can you treat atrial fibrillation during the same operation?

Yes. Atrial fibrillation can be ablated and the left atrial appendage closed through the same keyhole approach, which reduces future stroke risk.

Can mitral regurgitation go away on its own?

No. Once the valve structure is damaged it does not recover. Mild leaks can stay stable for years and are safely watched; severe leaks progress and should be treated.

What is the difference between mitral valve repair and MitraClip?

MitraClip is a catheter procedure that clips the leaflets together to reduce, not eliminate, the leak. It is reserved for patients too high-risk for surgery. For a fit patient with a repairable valve, surgical repair gives a more complete and more durable result.

How quickly can I be seen?

Usually within a week for a consultation, and the average wait for surgery is around two weeks.

Does private medical insurance cover keyhole mitral valve repair?

Most major UK insurers do. Our team handles the authorisation. Fixed-price self-pay packages are also available.

Have more questions or need advice about mitral valve regurgitation? Contact The Keyhole Heart Clinic at +44 (0)20 8079 7860.

The Keyhole Heart Clinic: Heart Experts You Can Trust.

Our team at The Keyhole Heart Clinic has pioneered minimally invasive cardiac surgery techniques. The clinic is led by Mr. Inderpaul Birdi, an expert in cardiovascular medicine with over 20 years of experience in keyhole surgery.

In expert hands, minimally invasive mitral valve repair has the same high success rate as open-heart surgery for fixing the valve problem, and patients recover with less discomfort and interruption to their lives.

Who will be operating on you

I am Mr Inderpaul Birdi, Consultant Cardiothoracic Surgeon (GMC 3407978), founder of The Keyhole Heart Clinic, and the surgeon featured in Channel 5’s documentary series The Surgeon.

• Over 20 years performing keyhole mitral valve repair and replacement, in more than 1,000 patients
• Over 35 years in clinical and surgical practice
• Operating at Cromwell Hospital, Kensington, London
• One of a small number of UK surgeons whose routine approach to mitral disease is keyhole rather than sternotomy
• Every operation performed by me personally, not delegated to a trainee

In addition to keyhole mitral valve repair surgery, our surgical offering includes:

• Keyhole coronary bypass surgery
• Keyhole tricuspid valve replacement
• Keyhole aortic valve replacement
• Keyhole atrial fibrillation ablation
• Keyhole atrial septal defect closure

Book your in-person or virtual consultation to discuss your options regarding mitral valve regurgitation. Let us help you take the next step toward a healthy heart and peace of mind.