The mitral valve controls blood flow from the heart’s upper left chamber, the left atrium, into the lower left chamber, the left ventricle. When damaged, the valve often leaks, a condition known as mitral regurgitation, causing blood to flow backward and strain the heart. Mitral valve repair (MVR) is the preferred surgical treatment because it restores the valve’s natural structure and function. This approach is associated with better long-term survival and maintenance of left ventricular function compared to replacing the native valve.
Expected Longevity of Mitral Valve Repair
A successful mitral valve repair is highly durable, particularly for degenerative valve disease. Durability is measured by freedom from needing a reoperation. For patients with degenerative mitral regurgitation, freedom from reoperation is typically 85% to 95% at ten years. Long-term studies indicate that 80% to 90% of patients remain free from reoperation twenty years after the original repair.
Mitral valve repair provides superior long-term survival rates compared to mitral valve replacement. For degenerative disease, survival rates for repair patients are significantly higher (e.g., 77% versus 57% at ten years and 46% versus 23% at twenty years). This improved survival results from better preservation of the heart’s pumping function and a lower incidence of valve-related complications.
Factors Influencing Repair Durability
Repair longevity depends on technical aspects and the patient’s health profile. The specific cause of the valve dysfunction is a major factor; repairs for degenerative disease are generally more durable than those for functional or ischemic mitral regurgitation. Degenerative disease involving only the posterior leaflet is often considered the simplest and most durable repair.
Repairs involving the anterior leaflet or both leaflets are technically more complex and carry a higher risk of needing reoperation. The surgeon’s experience and expertise are directly related to the quality and durability of the repair, with high-volume centers achieving the highest rates of long-term success. The presence of residual regurgitation immediately after surgery significantly increases the risk of later failure.
Patient-related variables also influence the long-term outcome, including age and underlying health conditions. Patients who are older or who have significant comorbidities like reduced left ventricular function or atrial fibrillation tend to have less favorable long-term results. Controlling post-operative risk factors such as high blood pressure and preventing infectious endocarditis is important for maintaining the integrity of the repaired valve.
Monitoring and Signs of Repair Deterioration
Long-term surveillance is important to ensure the valve remains functional and to detect deterioration early. The primary monitoring tool is the echocardiogram, typically performed annually or semi-annually. This imaging allows clinicians to measure the severity of recurrent leakage and assess left ventricular function.
The most common sign of deterioration is the recurrence of significant mitral regurgitation, which manifests as the gradual return of heart failure symptoms. Patients may notice increasing shortness of breath, especially when lying flat or during physical exertion, or excessive fatigue. Other symptoms include swelling in the legs or feet due to fluid retention.
Options Following Repair Failure
If the initial MVR fails, a second intervention is necessary to restore proper heart function. The preferred approach, if technically possible, is a re-repair of the valve, which maintains the benefits of the native valve apparatus. Re-repair is associated with lower perioperative mortality compared to replacement, though it carries a risk of needing another intervention later.
If the valve tissue is too damaged or the original components prevent a successful re-repair, surgical mitral valve replacement is required. This involves implanting either a mechanical valve (requiring lifelong blood thinners) or a bioprosthetic tissue valve (which typically needs replacement after ten to twenty years).
For high-risk patients, less invasive transcatheter options are emerging. These procedures, such as valve-in-ring (MVIR) replacement or transcatheter edge-to-edge repair (TEER), offer a less invasive route. However, they may have less durable results than surgical re-intervention. The choice of intervention balances the patient’s surgical risk profile with the need for a lasting solution.