Mitral Valve Stenosis: Repair or Replace the Valve?

If you have mitral valve stenosis and you need surgery to treat it, you have a choice of repairing the valve or replacing it. Three things play a role in this decision: the severity of your mitral valve stenosis, the possibility that it will get worse, and the risks of surgery.

Repair options

• Balloon valvotomy
• Repair surgery (commissurotomy)

Replacement option

• Mitral valve replacement surgery

What factors play a role in the decision?

When making this decision, you and your doctor need to consider:

• The condition of the valve and what is causing the stenosis. The more severe the stenosis, the more likely replacement will be needed.
• The surgeon's skill and experience in doing the procedures. Both valve replacements and balloon valvotomies are highly technical and should be done by an experienced surgeon.
• Whether you have a blood clot in your left atrium.
• How urgently you need treatment.
• Whether your heart rhythm is regular or irregular.

Your symptoms and the area of your mitral valve determine how severe your mitral stenosis is: the smaller the area, the lower the volume of blood that is able to pass through it, and so the more severe your stenosis. The pressure difference between your left atrium and left ventricle, as well as the blood pressure in your lungs, is also used to assess severity.

When is mitral valve repair recommended?

Generally, mitral valve repair is preferred if:

• Your valve is suitable for it.
• Your surgeon has the appropriate level of experience and surgical skill.

The advantages of mitral valve repair are that it:

• Preserves your natural valve.
• Leads to fewer complications and better postoperative results (generally lower risk of mortality) than mitral valve replacement.

The disadvantages of mitral valve repair are that:

• Not all valve problems can be repaired.
• The repair may not last and then you may need valve replacement surgery.

A balloon valvotomy is typically preferred over mitral commissurotomy as long as the doctor is experienced with the procedure. The two procedures have similar rates of success. A balloon valvotomy is a minimally invasive catheter procedure. A commissurotomy repair is typically an open-heart surgery using a heart-lung bypass machine.

When is mitral valve replacement recommended?

Valve replacement surgery might be done if the valve is damaged beyond repair.

This surgery is a major, open-heart surgery that puts a lot of stress on your body. It involves the risks associated with a major surgery. The exact risks of mitral valve surgery vary depending on the person's specific condition and general health prior to surgery. Younger, healthy people have a lower risk of problems. Older people with other health problems have a higher risk.

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