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A Guide to Mitral and Aortic Valve Repair and Replacement

The heart has four valves that ensure blood flows in the proper direction through the heart. The two most commonly discussed heart valves are the mitral valve and the aortic valve.

These two valves are located on the left side of the heart. The mitral valve separates the left upper and left lower chambers of the heart. The aortic valve is located at the top of the left lower chamber of the heart.   

The mitral and aortic heart valves are commonly affected by two main types of conditions: 

  • Regurgitation (leakage of the valve): The valve does not fully close, causing blood to flow backward. This forces the heart to pump more blood on the next beat, making it work harder.
  • Stenosis (narrowing of the valve): The opening of the valve narrows, limiting the flow of blood out of the heart’s chambers. This causes the heart to pump blood with increased force in order to move blood through the narrowed or stiff (stenotic) valve.  

“When the mitral and aortic heart valves fail to open and close properly, the heart's ability to pump blood adequately through the body is hampered. The implications for the heart can be serious and this issue can lead to a variety of complications, including heart failure,” says Prem Shekar, MD, Chief of Cardiac Surgery and Surgical Director of the Heart and Vascular Center at Brigham and Women’s Hospital (BWH).

Repairing the Mitral Valve    

Many surgical techniques are available to repair the mitral valve to enable it to open and shut efficiently.   

  • Decalcification to remove calcium and improve valve mobility
  • Repair of the fibrous strings that support the valves
  • Ring annuloplasty tightens the ring-like structure (the annulus) that supports the valve by inserting an artificial ring made of metal, tissue or cloth around the valve  
  • Patching holes to stop valve leakage  
  • Reshaping the leaflets to allow the valve to open and close more effectively  
  • Commisurotomy to open a narrowed valve

“There’s always the possibility that we may find advanced mitral valve disease during a mitral valve repair, in which case we will proceed with a valve replacement. We discuss this possibility with the patient before an operation,” says Dr. Shekar.   

Replacing the Mitral Valve       

A damaged mitral valve can be replaced with either a mechanical valve, or a biological valve.    

  • Mechanical valves are made of durable synthetic materials such as titanium and pyrolytic carbon. They last approximately 30 years, and recipients must take lifelong blood thinning medications (e.g., Coumadin or Warfarin). A mechanical valve is typically recommended for individuals 50 years or younger.
  • Biological valves are made from animal tissue (cow or pig). They last approximately 10 to 15 years, and patients do not require long-term blood thinning medications. A biological valve is recommended for those 65 or 70 and older.  

Learn more about mitral valve repair and replacement.

Repairing the Aortic Valve     

Several surgical techniques are available to tighten or loosen the aortic valve, so that the valve functions properly. Aortic valve repair can include surgical valvuloplasty to repair valve cusps so that it opens and closes more effectively.  

Replacing the Aortic Valve  

With aortic valve replacement surgery, the faulty valve is removed and replaced with an artificial valve. As with mitral valve replacement surgery, a damaged mitral valve can be replaced with either a mechanical valve or a biological valve. The decision to choose a mechanical or biological aortic valve depends on the unique needs of each patient.

“With the aortic valve, there are two additional, but less optimal options, for replacement. They include human cadaveric donor valve replacement, and autograft (Ross Procedure),” says Dr. Shekar.

Learn more about aortic valve repair and replacement.   

- Dustin G. 

In this video, Prem Shekar, MD, Chief of Cardiac Surgery, and Sary Aranki, MD, Associate Chief of Cardiac Surgery at BWH, discuss surgical treatments for heart valve conditions.