Once there was only one instrument for the treatment of mitral valve stenosis. The index finger. Surgeons would grope their way to the heart through a small chest incision, poke their index finger into the sticky valve, and pop it open with a quick thrust. With the development of open heart surgery, it became possible to replace stiff and leaky mitral valves with mechanical or bioprosthetic devices. Valve replacement was not a permanent solution and patients had to go on a lifelong blood-thinning regimen. The development of the Cosgrove-Edwards Annuloplasty System and other breakthroughs made mitral valve repair the gold standard at Cleveland Clinic and elsewhere – no lifelong blood-thinning or re-replacement necessary. Today, Cleveland Clinic does more mitral valve repairs than any center in America. Nearly all are done using new minimally invasive techniques that greatly reduce patient discomfort and recovery time. Robotically assisted minimally invasive mitral valve repair is also available. Because Cleveland Clinic does so many mitral valve repairs, it has been able to bring the mortality rate for all primary isolated mitral valve repairs at Cleveland Clinic down to zero (2010). Read more about mitral valve repair at Cleveland Clinic and minimally invasive repair.