Introduction
When faced with mitral valve disease, patients and families often wonder whether repairing the native valve or replacing it with a prosthesis is the better choice. This decision can feel overwhelming, but understanding the key differences - benefits, risks, and recovery - can help you make an informed choice in partnership with your heart team.
Body Sections
Indications for Repair vs Replacement
- Repair is ideal for degenerative valve disease (e.g., leaflet prolapse or flail) when the tissue quality is good.
- Replacement is indicated when the valve is too damaged, calcified, or when repair has a high risk of residual leak.
Advantages of Mitral Valve Repair
- Preserves native tissue and heart geometry
- Lower risk of infection (endocarditis)
- Avoids lifelong anticoagulation if repair is successful
- Better long-term survival and cardiac function
Advantages of Mitral Valve Replacement
- Predictable valve performance
- Shorter cross-clamp time in complex pathology
- Bioprosthetic options eliminate warfarin but may degenerate over time
- Mechanical valves last longer but require anticoagulation
Sternal Precautions
- Avoid lifting more than 10 pounds for 6–8 weeks
- Brace when coughing or sneezing to protect the sternum
- Use assistive devices for daily tasks
Driving, Flying, and Activity
- Driving: Typically safe after 4–6 weeks if pain is controlled
- Flying: Wait 4-6 weeks; consult for in-flight oxygen needs
- Exercise: Start with gentle walking, advance to cardiac rehab by week 2
Potential Complications
- Repair: Residual regurgitation or need for reoperation in ~5% of patients
- Replacement: Prosthesis malfunction, thrombosis, structural degeneration
Conclusion
For most patients with suitable valve anatomy, mitral valve repair offers superior outcomes - better survival, fewer complications, and improved quality of life. However, valve replacement remains a vital option when repair is not feasible. Discuss your individual risk factors, lifestyle, and valve pathology with your surgeon to choose the path that best meets your needs.
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Do you need a second opinion? Connect with our cardiac specialists today to receive a personalized MyVerus Report, outlining all your options.
