Heart Valve Repair vs. Replacement

Mitral valve replacement more durable than repair but other measures not significant

/ Author:  / Reviewed by: Joseph V. Madia, MD Beth Bolt, RPh

(RxWiki News) When a valve in the heart isn’t working efficiently, surgery may be necessary. There may be an advantage to replacing the valve rather than just repairing it, but not a very big one.

A recent study looked at the differences between mitral valve replacement and mitral valve repair in a group of patients who had ischemic mitral valve regurgitation.

The results of the study showed that valve replacement was more durable, but other clinical measures were similar between the groups.

"Talk to your surgeon about your valve repair options."

Michael A. Acker, MD, the Chief of Cardiovascular Surgery at the University of Pennsylvania Medical Center, led a team of researchers to investigate repair versus replacement of the mitral valve in the heart.

The mitral valve is one of four valves in the heart muscle. It separates the two left chambers of the heart and helps to pump blood out of the heart. If the mitral valve does not securely close, blood can leak and begin to flow backwards. This backwards blood flow is known as regurgitation, and it reduces the efficiency of the heart and total blood circulation.

For this study, 251 patients with severe mitral valve regurgitation due to ischemic causes (from a heart attack or coronary artery disease) were randomly split into two treatment groups. Patients in the first group had surgery to repair their mitral valve. Patients in the second group had surgery to replace their mitral valve.

After 12 months, the researchers tested the amount of blood remaining in the left ventricle heart chamber after the heart had pumped blood out through the mitral valve. There was no significant difference between the two groups.

Overall, 14.3 percent of the repair patients and 17.6 percent of replacement patients died.

Moderate to severe mitral valve regurgitation relapse happened in 32.6 percent of repair patients but only 2.3 percent of replacement patients after 12 months.

The authors of this study noted that no significant differences were found between groups for rates of stroke or heart attack or quality of life measures after 12 months, but that replacement offered a more durable correction compared with repair.

This study was published in November in The New England Journal of Medicine.

The National Heart, Lung, and Blood Institute, the National Institute of Neurological Diseases and Stroke, the National Institutes of Health and the Canadian Institutes of Health Research provided funding for this project. The authors declared no relevant financial conflicts of interest. 

Review Date: 
November 19, 2013
Last Updated:
November 20, 2013