Valve Choices in Mitral Valve Disease
Mitral Valve Repair
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” 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 70% to 80% 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:
Medtronic Mitral valve annuloplasty ring
Mechanical valve replacement
The benefit of mechanical valve replacement lies in the fact that modern valves demonstrate little or no evidence of structural deterioration. Their only caveat is that they can promote clot formation on their surface. For this reason, patients require life long anticoagulation with Warfarin, a daily tablet, which inhibits the clotting mechanism. A patient on Warfarin requires regular blood tests in order to ensure that the degree of inhibition is optimal. Excessive anticoagulation can produce dangerous bleeding complications that are more common in older patients.
St Jude Mechanical Mitral Valve
The On-x Carbon valve retains all of the properties of a mechanical valve with the potential advantage of reduced blood thinning requirements. Patients choosing this valve type are required to take a combination of Aspirin and lower dose Warfarin.
Cryolife, Inc On-X Carbon valve (Mitral)
Bioprosthetic (Tissue) valve replacement
Medtronic Hancock mitral bioprosthesis
A bioprosthetic valve can be made from pigs’ valves or from the pericardium of a cow. There is no risk of cross infection and Warfarin is not a requirement. Unfortunately, bioprostheses can wear away. Patients over the age of 70 years old can expect a durability of 75 to 80% at 10 years postoperatively. Younger, more active patients will wear down these valves much quicker.
Both mitral valve repair keyhole surgery and mitral valve replacement keyhole surgery is offered at The Keyhole London Heart Clinic.