Compared to valve replacement, mitral valve repair provides better long-term survival, better preservation of heart function, lower risk of complications, and usually avoids the need for long-term use of blood thinners. Despite the known benefits of repair over replacement, only about 55 percent of mitral valves nationwide are repaired.
The Mitral Valve Repair Program at Yale-New Haven
The Mitral Valve Repair Program at Yale-New Haven Hospital was the first in New England — and one of the first in the country — to perform mitral vale repair for Barlow mitral valve disease. Since 1984, our pioneering techniques, unparalleled performance records and compassionate, expert care, have attracted adult and pediatric patients from New Jersey, New York and New England for valve repair surgery.
The American Heart Association and the American College of Cardiology also advocate that valve repair surgery be performed in a high-volume hospital, like Yale-New Haven, where surgeons have the highest level of experience. A patient should ask and know ahead of time whether his or her valve will be repaired or replaced; a qualified, experienced center such as Yale-New Haven, can give the patient the answer well before undertaking the operative procedure.
Many cardiac surgeons can repair certain types of mitral valve disease some of the time. At Yale-New Haven, repair of all types of valve disease are done nearly all of the time.
Diagnosing mitral valve disease
A characteristic heart murmur can often indicate valve regurgitation. To further define the type of valve disease and extent of the valve damage, the Mitral Valve Repair Program relies on a transthoracic and transesophageal echocardiogram (TEE) — high-definition technology that offers valuable guidance to planning the valvular repair.
This noninvasive diagnostic test uses high-frequency sound waves that create images of the heart and its structures, including the mitral valve itself, to examine the flow of blood and measure amount of leakage (regurgitation). Preoperative studies like the echocardiogram are important in determining the need for surgery.
At Yale-New Haven, echocardiograms are acquired on seven state-of-the-art digital cardiac ultra-sound machines with the expertise of more than 15 certified sonographers. The echocardiograms are transmitted electronically to a digital archive, enabling rapid review and image comparisons by six board-certified cardiologists.
Mitral valve repair is technically more difficult than replacement, and operative success is dependent on the skill of the cardiovascular surgeon. Repair involves a lengthier and more complex surgery and requires the dedication of a committed and extremely proficient surgical team. At a comprehensive heart center like Yale-New Haven, this procedure is performed with a high degree of success and low operative risk.
When Yale-New Haven began performing mitral valve repair in 1984, it became the first center in Connecticut and one of a few in the country to introduce this cutting-edge procedure. The repair — which can employ various techniques, such as removal or reconstruction of mitral leaflets, or implantation of an annuloplasty ring to reinforce the frame of the valve, depending on the individual patient's condition — is considered to be the more attractive choice in many cases because the patient's own tissue is preserved during the procedure. The only artificial materials present in some cases are the annuloplasty ring that is used in the repair which becomes covered by the patient's own tissue and the artificial chordae made of Gore-tex. In about three to six months, there is no prosthetic material exposed to the blood.
Ischemic mitral valve disease
Ischemic mitral regurgitation (IMR) is present in 10 percent to 20 percent of patients with coronary artery disease, with a conservatively estimated prevalence of 1.6 million to 2.9 million patients in the United States alone. At the Mitral Valve Repair Center treatment for IMR using a combination of Gore-Tex neochordae and annuloplasty ring has achieved excellent results in more than 40 consecutive patients.
The Mitral Valve Repair Program also collaborates with pediatric cardiothoracic surgeons in treating children and adolescents with severe mitral regurgitation by offering them mitral valve repair instead of replacement. In this patient population the advantage of repair over replacement is magnified further. As with adults, mitral valve repair for pediatric patients can dramatically improve long-term natural functioning of the heart and can avoid prolonged use of anticoagulants.
Minimally invasive valve surgery
Traditional mitral valve repairs have involved cutting open the breastbone to repair the valve. At Yale-New Haven Hospital, most mitral valve repairs are performed through a 3-inch right thoroctomy incision using a window through the ribs. Post operative discomfort is reduced and patients can drive a week after discharge instead of the usual 2-3 weeks.