Ask These Questions Before Mitral Valve Surgery

By Debbe Geiger
Updated October 28, 2021

Dr. Donald Glower, MD, performs mitral valve surgery at Duke.

Mitral valve regurgitation can do serious damage to your heart. A leaky mitral valve causes blood to flow back into your heart, which makes it harder for oxygen-rich blood to be pumped out to your body. Because mitral valve regurgitation can lead to life-threatening heart failure, arrhythmias, and other abnormal heartbeats, your doctor may recommend heart valve surgery to repair or replace your mitral valve. Surgery may also be recommended if you have mitral valve stenosis, a less common condition that is defined by a narrowed mitral valve. It may also require a valve repair or replacement procedure.

Minimally Invasive Surgery for Mitral Valve Disease

Experienced heart surgeons have several options to treat mitral valve disease when medication is not enough. Typically, mitral valves are repaired or replaced. New minimally invasive techniques that use smaller incisions can return you to normal activities faster.

National Registry Tracks Mitral Valve Surgery Success

The STS national registry tracks mitral valve surgery success and complication rates at participating U.S. and international institutions to assess quality and safety. Hospital programs can use the information to compare their own data to the STS average rate.

Here renowned heart surgeon Donald Glower, MD, answers questions you should ask if you are considering surgery for mitral valve regurgitation or mitral valve stenosis. His answers also help you understand how Duke compares with STS benchmarks. This will help you find a surgeon and a hospital with the best outcomes.

1. Which is right for me: mitral valve repair or mitral valve replacement?

The answer depends on your anatomy and the condition of your mitral valve. A mitral valve repair restores the valve’s structure and function. Valves that cannot be repaired are replaced with a mechanical or prosthetic (tissue) valve. When recommending a valve, your surgeon will consider your age, lifestyle, and other medical conditions such as your ability to safely take blood-thinning medication. Tissue valves may last up to 20 years and do not require blood-thinning medicines. Mechanical valves are more durable and can last a lifetime but require blood thinning medications and periodic blood tests. Duke offers a full range of mechanical and tissue valves to people who need mitral valve surgery.

Your surgeon’s experience can impact the surgical outcome for mitral valve repair or replacement and may influence the treatment recommended for you. Repairing a mitral valve requires expertise and experience that not all surgeons have. Between 2015 and 2020, surgeons at Duke performed an average of almost 300 mitral surgeries per year, with repair of most degenerative valves and replacement of narrowed or stenotic valves.

 

Year Repairs Replacements Total
2015 161 147 308
2016 128 148 276
2017 149 146 295
2018 118 167 285
2019 110 152 262
2020 98 144 242

Source: Data provided by Duke.

2. What is the surgeon’s experience with open mitral valve surgery and minimally invasive mitral valve surgery?

Traditional mitral valve surgery is performed through a mid-chest incision and requires opening your breastbone. In contrast, minimally invasive mitral valve surgery can be performed through a small incision in your groin and a second small incision between two ribs in your chest. Duke surgeons also use robotic technology to perform mitral valve surgery. The benefits of this minimally invasive approach include less risk of bleeding, transfusion, and infection, along with a shorter hospital stay and a faster recovery. 

Minimally invasive mitral valve procedures require precision, experience, and skill that are acquired through training and by performing a large number of surgeries. More than 1600 minimally invasive mitral valve repairs have been performed at Duke since the program started in 1996.

3. What is my chance of surviving and doing well after mitral valve surgery?

As with any surgical procedure, mitral valve surgery has risks. The most serious complications associated with mitral valve surgery include stroke, placement of a pacemaker, kidney failure, lung failure, and wound infection. Fortunately, these are unusual. Your surgeon will discuss your personal risk for complications after mitral valve surgery.

Although age can be a risk factor for any procedure, research suggests people 65 and older do well and experience significant benefit from mitral valve procedures.

Duke’s overall survival and complication rates after mitral repair and replacement are better than the national average. In 2020, the survival rate for patients at Duke undergoing isolated mitral repair was 100% versus 99% in the STS national registry, and survival for isolated mitral valve replacement was 100% at Duke versus 94% in the STS.

 

Mitral Valve Repair Survival Rate

  2018 2019 2020
Duke 100% 100% 100%
STS 98.8% 99% 99%

 

Mitral Valve Replacement Survival Rate

  2018 2019 2020
Duke 96.9% 95.8% 100%
STS 95.5% 95.4% 94%

Source: Data Analyses of The Society of Thoracic Surgeons.

4. What’s my risk of complication?

In 2020, the rates of complications such as stroke, bleeding, kidney injury, and lung failure after mitral valve surgery were all lower among patients who underwent the procedure at Duke compared with the national average. 

 

Complication rates following mitral valve replacement

  2018 2019 2020
  Duke STS Duke STS Duke STS
Stroke 2.1% 1.8% 7.3% 1.9% 0% 2.3%
Renal failure 7.4% 4.4% 5.4% 4.86% 0% 5.3%
Prolonged ventilation 17.5% 16.4% 14.6% 16.5% 7.0% 17.4%

Source: Data Analyses of The Society of Thoracic Surgeons.

Key takeaways from 2020:

  • 0% of our patients suffered a stroke, compared to the national average of 2.3%. 
  • 0% of our patients experienced kidney (renal) failure, compared to the national average of 5.3%.
  • 7.0% of our patients experienced prolonged ventilation (required a ventilator for a prolonged period), compared to the national average of 17.36%.

 

Complication rates following mitral valve repair

  2018 2019 2020
  Duke STS Duke STS Duke STS
Stroke 1.2% 1.0% 0% 1.0% 0% 1.0%
Renal failure 1.2% 1.3% 0% 1.3% 0% 1.4%
Prolonged ventilation 4.6% 5.5% 1.0% 5.2% 2.5% 5.0%

Source: Data Analyses of The Society of Thoracic Surgeons.

Key takeaways in 2020:

  • 0% of our patients suffered a stroke compared to the national average of 1.0%.
  • 0% of our patients experienced renal failure, compared to the national average of 1.4%.
  • 2.5% of our patients experienced prolonged ventilation, compared to the national average of 5.0%.

Source: Data Analyses of The Society of Thoracic Surgeons.

5. What will my recovery involve?

You may require mild pain medication for a few weeks after discharge from the hospital. You should be back to your daily activities within four weeks after minimally invasive surgery and within eight to twelve weeks following the open-chest approach.

6. What if I am not a candidate for surgery?

If you are not a surgical candidate, mitral valve treatment options include medication and sometimes a less invasive procedure called MitraClip. This procedure is performed in the catheterization lab. A clip will be placed in your mitral valve through your groin. 

Duke is one of 40 U.S. medical centers to offer the MitraClip. While results following a MitraClip procedure may not last as long a mitral valve surgical procedure, studies show people who receive the MitraClip experience a better quality of life, fewer readmissions to the hospital for heart failure, and better long-term survival, when compared to patients who only received medication.

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Mitral valve disease surgery