Ask the Doctor: Asad Shah, M.D.


asadShahQ. What are the benefits of mitral valve repair versus replacement?

A. Sometimes it is better to repair the mitral valve, and sometimes it is better to replace it. There are many factors to consider when deciding which route we will take. First, if the valve is very tight (stenotic), then patients will benefit from a mitral valve replacement the vast majority of the time.

If the valve is leaky (regurgitation or prolapse), whether to repair or replace the valve depends, at least partially, on what the cause of the leak is. If the leakiness is from weakened heart muscle, the patient may have a better long-term outcome with mitral valve replacement. If the valve is leaking due to degeneration, or breakdown, the patient will likely do better with a mitral valve repair.

One thing to keep in mind though, for degenerative mitral valve regurgitation, you, as the patient, don’t want just a repair – you want a repair that is going to last a long time. It would be better to replace the valve than repair the valve if the repair is only going to last 2 years. This is the area where I believe Hoag has a great advantage.

It takes a skilled, experienced surgeon to perform a mitral valve repair or replacement. Hoag’s exceptional cardiac surgery team, which performs mitral valve surgeries, is comprised of expert physicians and staff committed to ensuring the highest quality outcome for patients.

The Nancy & Bill Thompson Heart Valve Center at Hoag is a nationally recognized leader, and repairs more heart valves than 90 percent of all cardiac programs in the United States. Additionally, 95 percent of Hoag patients who are eligible for a repair choose this treatment method instead of heart valve replacement, due to the benefits I listed above.

The goal of mitral valve repair is to restore function to the patient’s own valve. This is more advantageous to patients in many instances, compared to replacement, since it leaves a patient's own living tissue functioning normally. It also provides a long-term solution to restoring heart valve function, and significantly reduces a patient’s risk of experiencing complications. Mitral valve repair has been proven in multiple studies to be superior to valve replacement for degenerative mitral valve regurgitation in terms of surgical mortality, valve function and long-term survival. Mitral valve repair gives patients an 80 percent chance that they may go the rest of their life without any further surgery on that valve.

Patients who undergo a repair are also not required to be on long-term medication therapy with blood thinning agents (coumadin or warfarin). This is important as blood thinners are known to increase the risk of bleeding, and may lead to stroke or other medical problems. In addition, they can cause severe birth defects, and therefore cannot be used in women who may become pregnant.

To determine if you are a candidate for mitral valve repair, speak with your cardiologist, or contact the Thompson Heart Valve Center at Hoag to schedule an appointment at 949-764-8258.

Asad Shah, M.D., is a cardiac surgeon with the Jeffrey M. Carlton Heart & Vascular Institute at Hoag.