Valve Choices in Mitral Valve Replacement

Types of Mitral Valve Replacements

Disclaimer: The information on this page is for general guidance only and does not replace an individual clinical consultation.

Patients may require valve replacement when the mitral valve becomes severely damaged or fails to function properly. This most commonly occurs in conditions such as mitral valve stenosis (the valve narrows) or mitral regurgitation (the valve does not close tightly, allowing blood to leak).

Mechanical valves and biological valves are widely used in mitral valve replacement surgery. Researchers have compared outcomes between these two valve types in various studies, but ongoing debate continues over which option is best for different patients.

A meta-analysis of 22 studies involving more than 35,000 patients compared mechanical and biological mitral valve replacements.

The analysis found that mechanical valves were associated with:

• 16% lower long-term mortality
• 66% lower risk of repeat mitral valve surgery

These findings depend on patient characteristics such as age, overall health, and suitability for anticoagulation.

However, mechanical valves were also linked to:

• Higher risk of major bleeding
• Higher risk of stroke or systemic embolism

The study found no significant difference in early surgical mortality between the two valve types.

Learn more about the types of valve replacements.

Mechanical Mitral Valve Replacement

Mechanical mitral valves have three main components:

1. Occluder: The moving part that opens and closes to control blood flow between the left atrium and left ventricle.
2. Valve housing: A strong ring-shaped structure that supports and guides the moving parts so the valve opens and closes smoothly with each heartbeat.
3. Sewing ring (sewing cuff): A fabric-covered ring that allows the surgeon to securely stitch the valve into the heart during mitral valve replacement surgery.

Most modern mechanical valves are made primarily of pyrolytic carbon, a durable, biocompatible material. The sewing ring is typically made from synthetic fabric to help the valve attach securely to the surrounding heart tissue.

Possible Complications of Mechanical Valves

As with any cardiac device, mechanical valves carry risks that should be carefully considered alongside their benefits.

• Bleeding: Anticoagulation therapy increases the likelihood of significant bleeding, which can be life-threatening in some cases.
• Infection: Prosthetic valves carry an ongoing risk of endocarditis post-heart valve surgery.
• Valve dysfunction: While structural deterioration is rare, mechanical artificial valves may be susceptible over time.

Biological Mitral Valve

A biological mitral valve, also known as a bioprosthetic valve or tissue valve, is a replacement heart valve made from natural animal tissue. These valves are most commonly created from cow (bovine) or pig (porcine) tissue, which is specially treated and mounted on a supporting frame so it can function like a natural heart valve.

They are widely used in mitral valve replacement surgery and are often chosen because they usually do not require lifelong anticoagulant (blood-thinning) medication.

Possible Complications of Bioprosthetic Valves

As with any type of heart valve replacement, bioprosthetic valves can be associated with certain complications, although many patients see positive results for many years.

Potential complications may include:

• Structural valve deterioration, where the valve gradually becomes worn or calcified
• Valve dysfunction, meaning the valve does not open or close properly
• Valve thrombosis, where a blood clot forms on the valve
• Infection of the new valve (endocarditis)
• The need for a repeat valve procedure if the valve eventually fails

Regular follow-up appointments and heart imaging tests, such as echocardiography, help doctors monitor valve function and detect problems early.

Choosing Your Heart Valve Replacement

For many patients with mitral valve disease, the valve can be repaired rather than replaced. However, when replacement is necessary, the care team will carefully consider the choice between a mechanical and a biological valve.

International guidelines, including the 2025 ESC/EACTS Guidelines for the Management of Valvular Heart Disease, recommend that this decision be based on factors such as age, life expectancy, lifestyle, bleeding risk, pregnancy plans and patient preference.

Your heart surgeon will discuss these options with you and recommend the valve type that best suits your medical needs and lifestyle.

Follow-Up After Mitral Valve Replacement

Whether the mitral valve is repaired or replaced, regular follow-up is important to monitor long-term heart health. European guidance recommends periodic clinical review and echocardiography after treatment.

For patients with biological valves, scans are usually performed:

• Within the first few months after heart valve surgery
• At one year
• Annually thereafter
• Sooner if symptoms develop

These checks allow your care team to monitor the valve’s function and recognise problems early. In some situations, additional imaging tests may be recommended if concerns arise about valve function, infection or blood clots during recovery.

Why Mitral Valve Repair is Preferred When Possible

Unlike the aortic valve, many patients with mitral valve disease who require surgery will benefit most from mitral valve repair rather than replacement. Repairing a mitral valve confers many advantages, including preserved heart function, reduced surgical mortality, and avoidance of anticoagulation. The procedure requires considerable experience.

“Our team are one of the most experienced in the United Kingdom, and have performed several hundred such procedures in several units, including London and Essex, over the last 10 years” – Mr Inder Birdi

The probability of repair depends upon a number of factors:

• Posterior leaflet prolapse 95% to 98% chance of repair
• Anterior leaflet prolapse 85% to 90% chance of repair
• Bileaflet prolapse over 90% chance of repair

The presence of extensive leaflet calcification limits the quality of repair and is therefore only performed in highly selected cases. If the valve cannot be repaired, then mitral valve replacement will be required.

When we repair the mitral valve, we often implant a band or ring around the valve to secure the shape of the mitral valve opening.

FAQs

Find out more about bioprosthetic and mechanical mitral valve replacements.

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About the Medical Reviewer

Medically reviewed by Mr Inderpaul Birdi, MBBS, MD, FRCS (CTh)
Consultant Cardiothoracic Surgeon | Clinical Lead, The Keyhole Heart Clinic
GMC Registration: 3407978

Mr Inderpaul Birdi is a Fellow of the Royal College of Surgeons with over 20 years’ experience as a Consultant Cardiac Surgeon, specialising in keyhole thoracic and cardiovascular surgery. He trained at the Royal Papworth Hospital and the Royal Brompton Hospital.