While mitral valve disease can lead to severe heart failure, it can often be solved with open surgery. But, what if you are unable to undergo major surgery because of other health issues?
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Medication is sometimes a solution, but surgeons also may use minimally invasive options to repair the mitral valve. Researchers are also investigating several promising mitral valve replacement options.
“Percutaneous (through the skin) mitral valve repair and replacement techniques are rapidly growing. They help patients who currently do not have good surgical options and for whom medical treatments are not working well,” says structural heart disease specialist Samir Kapadia, MD, who directs cardiac catheterization laboratory at the Cleveland Clinic.
How your symptoms affect your options
The mitral valve allows oxygen-rich blood flowing from the lungs to return to the heart.
“The most common valve problem is leakage, also known as mitral valve regurgitation,” Dr. Kapadia says. “If the blood leaks back into the lungs, it causes you to have shortness of breath.”
If your valve doesn’t open properly, this is known as mitral valve stenosis.
“We see mitral valve stenosis in patients who were exposed to a lot of radiation from breast cancer or lung cancer treatments or in some patients with calcification of mitral valve without obvious causes,” he says.
If you have mild symptoms from a malfunctioning mitral valve, medication might be all you need. However, if you have more severe symptoms — shortness of breath or chest pain — the valve will likely need repair or replacement.
If failing health or a weak heart makes open surgery a higher risk for you, there are safer surgical options.
“In some situations, mitral valve disease is not life threatening and does not require surgery,” Dr. Kapadia says. “If surgery is recommended and you’re high risk for surgery, we can either repair or replace the mitral valve with minimally invasive procedures.”
What are your options?
If your surgeon needs to repair your mitral valve through tiny incisions (without opening up your chest), here are minimally invasive surgical options:
- Right mini-thoracotomy. The surgeon inserts special instruments and repairs the valve through a 2- to 3-inch incision in a skin fold on the right side of the chest.
- Partial upper sternotomy. This also involves a 2- to 3-inch incision, this time in the upper portion of the sternum. This gives the surgeon easier access to repair the valve.
- Robotically assisted mitral valve repair.In this case, your surgeon works through a few incisions of about 1 inch or less. With a computer console, the surgeon can control instruments on thin robotic arms. This allows him or her to open the thin sac around your heart to perform the repair.
However, as these require your surgeon to stop the heart, you may not be a candidate for surgical minimally invasive repairs. In this case, percutaneous repair or replacement may be feasible, such as the following options:
- MitraClip. This is a clip inserted through the groin vein to repair deformed mitral leaflets. It is FDA- approved for patients with severely leaking valves who are at high risk for conventional surgery.
- Percutaneous rings. There are ways to repair mitral valves using rings that can be inserted through the groin or neck veins to help the valve close better. They are available under clinical trials at this time.
- Transcatheter mitral valve replacement (TMVR). In this procedure, a surgeon guides a hollow catheter into your heart through a vein in your groin vein. He or she then inserts the replacement valve and expands it directly into the failing mitral valve. This technique does not yet have FDA approval for widespread use. “There are currently four of these valves being tested in clinical trials across the United States,” Dr. Kapadia says.
Since there are several treatment options for patients who cannot have open surgery, Dr. Kapadia recommends seeking a healthcare facility with a mitral valve center.
“To choose the appropriate therapy and obtain the best outcome, seek an evaluation from an experienced team of specialists. This is essential,” he says. “You can only get that from a dedicated mitral valve center of excellence.”