Mitral Regurgitation: Repair or Replace? | Dr. Rafik Soliman
The mitral valve separates the left atrium from the left ventricle. When it narrows (stenosis) or leaks (regurgitation), the heart and lungs work harder and symptoms such as breathlessness, fatigue and palpitations can appear. In many cases of regurgitation the valve can be repaired rather than replaced, preserving the patient's own tissue.
Why repair is preferred when feasible
Repair preserves the valve's anatomy and left-ventricular function, and patients usually avoid the lifelong blood thinners required with mechanical valves. Whether repair or replacement is right depends on the echo findings and the cause of disease, and can only be decided after examination.
How the minimally invasive approach works
In suitable patients a small incision is made on the right side of the chest between the ribs instead of dividing the breastbone, with endoscopic assistance to visualise the valve. Techniques include an annuloplasty ring and leaflet or chord reconstruction. The heart-lung machine is used as in conventional surgery.
Who may be a candidate?
Assessment includes transthoracic and often transoesophageal echocardiography, with coronary angiography or CT depending on age and history. Not every patient is suitable for the endoscopic route; conventional surgery may be the safer option for some.
Recovery
Hospital stay and recovery vary between patients. Avoiding division of the breastbone may help some patients return to daily activities sooner. The medical team sets each patient's follow-up and medication plan.
Further medical reading
Independent educational references; individual treatment choices require a clinical assessment.
Mitral regurgitation: repair or replacement? Video with Prof. Dr. Rafik Soliman
This Facebook post discusses when follow-up is sufficient, when severe mitral regurgitation may warrant intervention despite no symptoms, and why durable valve repair is preferred when feasible.
For selected patients, a minimally invasive right-sided chest incision may be an option. Treatment and timing depend on echocardiographic findings, symptoms and the Heart Team assessment.