Mitral Valve Surgery

The mitral valve plays a critical role in keeping blood flowing efficiently through the heart. When this valve becomes damaged or diseased, it can lead to symptoms such as shortness of breath, fatigue, and swelling, and may eventually weaken the heart muscle. Mitral valve surgery offers a way to repair or replace the faulty valve, restore normal blood flow, and protect long-term heart health.

For patients facing this decision, understanding the available treatment options is essential. The best approach depends on the specific valve problem, its severity, overall heart function, age, medical history, and whether the patient is suitable for traditional open surgery, minimally invasive techniques, robotic-assisted procedures, or catheter-based treatments.

This guide explains the main types of mitral valve surgery, how each procedure is performed, what recovery involves, and what patients should consider when evaluating treatment options.

Mitral Valve Disorders That Typically Require Surgical Intervention

The mitral valve controls blood flow between the left upper and lower chambers of the heart. When it does not work properly, the heart must work harder to pump blood.

Mitral valve disorders generally involve one or more of the following:

• Mitral valve regurgitation: The valve leaks, allowing blood to flow backward.

• Mitral valve stenosis: The valve opening is narrowed, making it harder for blood to move forward.

• Mitral valve prolapse: The valve leaflets bulge backward and may not close smoothly.

For patients considering surgery, the key question is whether the valve problem requires medication and monitoring alone, or whether repair or replacement is needed. This decision depends on the severity of the valve problem, symptom severity, and how the heart is responding to the increased workload.

For a broader overview of these conditions, including their causes, symptoms, and diagnosis, read our dedicated guide on mitral valve disease.

When Is Surgery Recommended?

Mitral valve surgery may be recommended when the valve problem is severe, symptoms affect daily life, the heart begins to enlarge or weaken, or there is a high risk of complications without treatment. In some patients, surgery is advised before major symptoms develop because waiting too long can cause permanent changes in heart function.

A cardiologist and cardiac surgeon consider several factors when recommending surgery:

• Whether the valve is leaking, narrowed, or both

• The severity of the valve problem

• Shortness of breath, fatigue, swelling, or reduced exercise ability

• Heart rhythm problems, such as atrial fibrillation

• Heart size and pumping strength

• Increased pressure in the blood vessels of the lungs

• Age, general health, and other heart conditions

• Whether repair is likely to provide a durable result

Heart valve surgery is not always the first step. Mild disease may be monitored with regular echocardiograms, medication, and follow-up appointments. Medication can help manage symptoms or complications, but it cannot permanently correct a severely damaged valve.

Treatment Options: Repair, Replacement, and Catheter-Based Procedures

The choice of treatment depends on the type of valve disease, its severity, the patient's overall health, and the experience of the cardiac surgery team. The main options are mitral valve repair, mitral valve replacement, and transcatheter procedures such as the MitraClip.

Mitral Valve Repair

Mitral valve repair surgery preserves the patient's own valve. Whenever a long-lasting repair is possible, it is often preferred to mitral valve replacement because it keeps the natural valve tissue and usually avoids the need for lifelong blood-thinning medication.

During mitral valve repair, the surgeon may reshape the valve leaflets, repair torn supporting cords, remove excess tissue, or place a supporting ring around the valve opening. The ring helps the valve close more effectively and is called an annuloplasty ring.

The choice of repair technique depends on the cause of the valve problem. Repair can be particularly successful for certain types of valve prolapse and degenerative regurgitation, in which the valve has gradually weakened or stretched over time.

Potential advantages of mitral valve repair include:

• Preserving the patient's natural valve

• Restoring more normal blood flow

• Avoiding some risks associated with replacement valves

• Reducing the need for long-term anticoagulants in many patients

• Supporting long-term heart function when performed at the appropriate time

Not all valves can be repaired. Severe scarring, calcification, infection, rheumatic disease, or extensive valve damage may make replacement the safer or more reliable option.

Mitral Valve Replacement

Mitral valve replacement involves removing the damaged valve and implanting an artificial valve. It is used when mitral valve repair is not possible or is unlikely to provide a lasting result.

Replacement valves are generally divided into two categories:

• Mechanical valves: Made from durable artificial materials. They can last for many years but usually require lifelong anticoagulant medication to reduce the risk of blood clots.

• Biological valves: Made from animal tissue and sometimes called tissue valves. They may not require lifelong anticoagulant medication in every patient, but they can wear out over time and may eventually need another procedure.

The choice between a mechanical and biological valve depends on age, lifestyle, bleeding risk, other medical conditions, pregnancy plans, personal preferences, and the likelihood of needing future procedures. A cardiac surgeon explains the advantages and limitations of each option before mitral valve replacement surgery.

Mitral Valve Repair vs Replacement

Mitral valve repair vs replacement is an important treatment decision. Repair is generally preferred when the surgeon expects a durable result because it preserves the patient's own valve and may offer better long-term heart function. Replacement is necessary when the valve is too damaged, stiff, scarred, infected, or calcified to repair reliably.

The decision is based on detailed imaging, including echocardiogram and sometimes cardiac CT or MRI. It should also consider the experience of the cardiac surgery team, because complex mitral valve repair requires specific expertise.

Transcatheter Edge-to-Edge Repair (TEER)

Transcatheter edge-to-edge repair (TEER) is a catheter-based procedure for selected patients with severe mitral valve regurgitation who are at high risk for conventional surgery. During TEER, a doctor guides a thin tube called a catheter through a blood vessel in the groin to reach the heart. A small clip is then attached to the leaking valve leaflets to help them close more effectively.

The MitraClip is the most widely used and studied device for performing TEER. This device is a small, permanent clip that grasps the edges of the mitral valve leaflets and holds them together, creating a double opening that reduces backward blood flow. While other TEER devices exist, MitraClip has the most extensive clinical experience and long-term data.

TEER may be considered when:

• Mitral regurgitation is severe

• Symptoms persist despite appropriate medical treatment

• Open surgery carries high or prohibitive risk

• The valve anatomy is suitable for the procedure

• The patient is assessed by a multidisciplinary heart team

TEER is less invasive than open heart valve surgery, but it is not a replacement for surgical repair in every patient. Surgery may offer a more complete and durable repair for people who are otherwise suitable for an operation.

How Mitral Valve Surgery Is Performed

Traditional mitral valve surgery is performed through an incision in the center of the chest. The breastbone, also called the sternum, is carefully opened to give the surgeon access to the heart. During most open and minimally invasive mitral valve operations, a heart-lung machine temporarily takes over the heart's pumping and oxygenating functions while the valve is repaired or replaced.

The main stages of the mitral valve surgery procedure include:

1. General anesthesia is given so the patient is asleep and does not feel pain.

2. The surgical team accesses the heart through the planned incision.

3. The heart-lung machine supports circulation during the operation.

4. The surgeon repairs the valve or removes it and places a replacement valve.

5. Heart function and valve performance are checked with ultrasound.

6. The incision is closed, and the patient is transferred to intensive care for close monitoring.

The exact duration of surgery varies depending on whether the valve is repaired or replaced, whether other procedures are performed at the same time, and the patient's individual condition.

Surgical Approaches: Traditional, Minimally Invasive, and Robotic

Mitral valve surgery can be performed using different surgical approaches. The choice depends on the patient's condition, anatomy, and the surgical team's expertise.

Traditional Open Surgery

Traditional mitral valve surgery is performed through an incision in the center of the chest. The breastbone, also called the sternum, is carefully opened to give the surgeon direct access to the heart. This approach provides excellent visibility and is suitable for most patients, including those who need multiple heart procedures.

Minimally Invasive Surgery

Minimally invasive mitral valve surgery uses smaller incisions, usually between the ribs on the right side of the chest, rather than opening the breastbone. This approach may reduce tissue trauma and can support a shorter hospital stay and faster recovery for appropriately selected patients.

Minimally invasive surgery is not suitable for everyone. It may be less appropriate when a patient needs multiple heart procedures, has certain blood-vessel conditions, has had some previous chest operations, or has anatomy that makes traditional surgery safer.

Robotic-Assisted Surgery

Robotic mitral valve surgery is a type of minimally invasive procedure in which the surgeon controls specialized robotic instruments through small chest incisions. Robotic surgery provides high-definition, three-dimensional visualization of the valve while allowing surgeons to perform precise repair techniques without a large chest incision.

Robotic mitral valve surgery should be performed by a dedicated, experienced cardiac surgery team. The technology supports the surgeon's movements; it does not perform surgery independently.

All three approaches can be used for mitral valve repair, mitral valve replacement, or certain transcatheter procedures. The best approach depends on the individual patient's needs and the surgical team's expertise.

Recovery After Mitral Valve Surgery

Mitral valve surgery recovery begins in the intensive care unit, where the team monitors heart rhythm, breathing, blood pressure, drainage tubes, and pain control. Most patients stay in intensive care for one or two days, followed by several days in a hospital room.

Recovery after traditional open surgery commonly takes several weeks. The breastbone needs time to heal, so lifting, driving, and strenuous activity are restricted initially. Recovery after minimally invasive mitral valve surgery may be shorter, although it still requires careful follow-up and gradual return to activity.

During recovery, patients may be advised to:

• Take medication exactly as prescribed

• Attend scheduled cardiology and surgical appointments

• Walk regularly and increase activity gradually

• Perform breathing exercises when recommended

• Avoid heavy lifting until cleared by the surgical team

• Follow incision-care instructions

• Watch for fever, redness, drainage, worsening shortness of breath, or palpitations

• Participate in cardiac rehabilitation when appropriate

Cardiac rehabilitation is a medically supervised program of exercise, education, and lifestyle support that helps people regain strength and confidence after heart surgery. Regular echocardiograms are needed after repair or replacement to monitor valve function over time.

Risks and Complications

All forms of heart valve surgery involve potential risks. The individual risk depends on age, overall health, heart function, kidney and lung health, other medical conditions, the type of procedure, and whether surgery is planned or performed urgently. Patients with existing cardiovascular disease, such as coronary artery disease or previous heart attacks, may have higher surgical risk and require more detailed preoperative assessment.

Potential mitral valve surgery risks include:

• Bleeding or need for blood transfusion

• Infection, including infection of the surgical wound or heart valve

• Irregular heart rhythms

• Blood clots, stroke, or heart attack

• Kidney or lung complications

• Temporary confusion or memory changes, especially in older adults

• Problems with the repaired or replacement valve

• Leakage around a replacement valve

• Need for a pacemaker

• Reoperation or another catheter-based procedure

• Death, which is uncommon but remains a risk of major heart surgery

A detailed preoperative assessment helps the heart team estimate risk and choose the safest treatment pathway. Hospitals performing cardiac surgery should have experienced cardiac surgeons, anesthesiologists, intensive care specialists, perfusion teams who operate the heart-lung machine, and advanced intensive care resources.

Understanding the Cost of Mitral Valve Surgery

Mitral valve surgery cost depends on the procedure, complexity of the valve disease, hospital stay, intensive care needs, use of robotic or minimally invasive technology, type of replacement valve, tests, medication, and follow-up requirements.

Mitral valve repair surgery cost may differ from mitral valve replacement surgery cost because the procedures require different surgical techniques and materials. A MitraClip procedure also has a separate cost profile because it uses specialized catheter equipment and implanted devices.

International patients considering mitral valve surgery in Turkey should request an individualized treatment and cost plan after their medical records, echocardiogram images, and current health status have been reviewed. Cost should be considered together with hospital capability, surgeon experience, anesthesia support, intensive care resources, and postoperative follow-up.

Comprehensive Cardiovascular Surgery Services at Medical Park Hospitals

Medical Park Hospitals provide comprehensive cardiovascular surgery services in Turkey for both local and international patients, offering the full range of mitral valve treatments, including mitral valve repair, mitral valve replacement, and transcatheter edge-to-edge repair (TEER). Patients receive multidisciplinary assessment involving cardiologists, cardiovascular surgeons, anesthesiologists, and intensive care teams. This collaborative approach helps determine whether medical monitoring, surgical repair, valve replacement, or transcatheter treatment is most appropriate for each individual.

JCI-accredited Medical Park Hospitals are equipped for complex cardiac surgery with advanced operating rooms, intensive care units, diagnostic imaging, and perfusion services. The surgical teams have experience in traditional open surgery, minimally invasive techniques, and robotic-assisted procedures. For international patients considering cardiovascular surgery in Turkey, Medical Park provides coordinated care that includes preoperative assessment, surgery, intensive care monitoring, hospital recovery, discharge planning, and follow-up guidance.