“Valve repair success”
How successful is valve repair vs replacement? How do youu know when to do which procedure?
18 Answers
Replacement is more durable
Depending on which valve and what are the causes which made the valve or valves not function normally. For leaking valve, repair is much better than replacing the valve, especially if caused by degradation, like worsening mitral valve prolapseor a birth defect. The heart functions better if we repair rather than replace the valve.
Valve repairs are generally limited to either the mitral or tricuspid valves, both of which are "inlet valves" leading to the main pumping chambers of the heart (ventricles). Repairs can be accomplished in about 90% of situations where the mitral valve is leaking, and almost always where the tricuspid valve is leaking. A surgeon can look at a preoperative echocardiogram and determine whether a repair will be likely. A repair is favored as it is often more durable than an artificial valve, it preserves the heart's geometry and ability to pump efficiently, and can help avoid the use of blood thinners after the operation.
Depending on what valve needs repair or replacement and the reason why surgery is indicated.
Any procedure depends on the skill set of the surgeon who is doing it. Valve repair if feasible is always preferred over replacement. We decide based on anatomy of the valve and feasibility of repair.
This is a complicated question. It depends on the valve in question and the problem that one is trying to correct. Repair is usually preferable if possible but is not always possible.
Repair is most often done with the mitral valve when it has a significant leak. However, if it is stenotic (narrowed) most often it is replaced. Surgery on the aortic valve is most often done by replacement. The determination of replace versus repair depends upon the structure of
the mitral valve and whether some of the surrounding tissues can be fixed to allow the valve to function more normally. A non-invasive echocardiogram is necessary to evaluate the valves prior to the decision and can be discussed with you before surgery. I usually show the images to the patient's in my office. Repair is done by removing redundant tissue or tightening the surrounding structures. In some cases this is not possible, thus the valve would be replaced. Repair, leaving the patient's native valve in place is preferable with better long-term outcomes.
Regards,
M. Denton Stam, MD MBA
the mitral valve and whether some of the surrounding tissues can be fixed to allow the valve to function more normally. A non-invasive echocardiogram is necessary to evaluate the valves prior to the decision and can be discussed with you before surgery. I usually show the images to the patient's in my office. Repair is done by removing redundant tissue or tightening the surrounding structures. In some cases this is not possible, thus the valve would be replaced. Repair, leaving the patient's native valve in place is preferable with better long-term outcomes.
Regards,
M. Denton Stam, MD MBA
Always be in favor of repair over replacement. You get to keep your own valve rather than having an artificial prosthetic valve that can initiate its own problems. The key to a successful repair is having a surgeon who performs many repairs. Do your homework on surgeon and institution where s/he works. Both need good credentials. The Society of Thoracic Surgeons (sts.org) is a good starting point. Valve repair is an art/skill that takes practice. A bad result is no repair.
The decision for valve repair vs replacement is dependent on the valve involved, the etiology and severity of the valve disease, patient characteristics and surgeon.
It depends on which valve is involved. If symptoms are present, then the valve needs to fixed surgically. To determine whether to do a repair or replacement is dependent upon each patient and their specific condition. In case of mitral valve, usually a repair is possible.
Thank you for your question.
Valve repair is always the best option when it is available. In the mitral and tricuspid valve position, repair has become the standard of care if you can leave the valve as good as new. If in fact the repair will leave the valve sub-optimal, then replacement is warranted.
Thank you...
Valve repair is always the best option when it is available. In the mitral and tricuspid valve position, repair has become the standard of care if you can leave the valve as good as new. If in fact the repair will leave the valve sub-optimal, then replacement is warranted.
Thank you...
Julia G. Ansari
Cardiologist
For mitral valve, you prefer mitral valve repair to not disturb the structure, but it all depends on calcification and the tissue. If the valve is heavily calcified, it may not be reparable and only when the surgeon opens you up, they know what is your best option. Aortic valve mostly have to be replaced unless there was an infection of the valve that caused leakage and in some cases, the surgeon may be able to repair that.
A properly repaired mitral valve offers several advantages over mitral valve replacement. When compared to mitral valve replacement, successful mitral valve repair has fewer surgical complications, better long term heart function and improved long term survival.
The decision to repair vs replace the mitral valve depends on the cause of the valve problem and the likelihood that the mitral valve can be successfully repaired. For example, patients with the most common forms of mitral valve problems can usually be successfully repaired. However, mitral valve problems caused by rheumatic fever may not be repairable and may require valve replacement.
My philosophy is to repair the mitral valve whenever possible. This can be accomplished in greater than 90% of patients with the most common form of mitral valve problems and in greater than 70% of patients with more complex forms of mitral valve problems.
The decision to repair vs replace the mitral valve depends on the cause of the valve problem and the likelihood that the mitral valve can be successfully repaired. For example, patients with the most common forms of mitral valve problems can usually be successfully repaired. However, mitral valve problems caused by rheumatic fever may not be repairable and may require valve replacement.
My philosophy is to repair the mitral valve whenever possible. This can be accomplished in greater than 90% of patients with the most common form of mitral valve problems and in greater than 70% of patients with more complex forms of mitral valve problems.
Naji Kholaif
Cardiologist
So there are different valves which are treated differently.
In adults the aortic valve is usually only replaced surgically or percutanously as is the pulmonic valve. The tricuspid valve is rarely replaced and usually repaired.
Usually the question is about the mitral valve.. and the answer to that, is that a repair is always attempted because if repaired well there will be no need for blood thinners and the results are long lasting. The success rate of being able to repair a valve depends on what was the pathology that lead to the leaking valve? And which part of the valve is damaged and how extensive. A favorable anatomy of the mitral valve repaired in a high volume Centre has a success rate of over 95%.
In adults the aortic valve is usually only replaced surgically or percutanously as is the pulmonic valve. The tricuspid valve is rarely replaced and usually repaired.
Usually the question is about the mitral valve.. and the answer to that, is that a repair is always attempted because if repaired well there will be no need for blood thinners and the results are long lasting. The success rate of being able to repair a valve depends on what was the pathology that lead to the leaking valve? And which part of the valve is damaged and how extensive. A favorable anatomy of the mitral valve repaired in a high volume Centre has a success rate of over 95%.
It depends on a lot of variables, especially the status of the valve
itself. This question deserves a long and personal exposition, preferably
by an interventional cardiologist who performs them.
itself. This question deserves a long and personal exposition, preferably
by an interventional cardiologist who performs them.
Valve repair of the mitral valve has much less complications that mitral valve replacement - if it's feasible. Repair is usually done when there is excess mitral valve leaflet. The surgeon cuts away the excess and then sews the remaining leaflets back together. It's very successful, when it can be done. However, most mitral valve operations are on very stiff, calcified, contracted valves that cannot be resected properly, so a replacement is necessary. We have found newer tissue valves are longer lasting than they used to be. So repair if you can, depending on the exact circumstances of your valve.
Juan P. Montoya
Cardiothoracic Surgeon
Depends on which valve you are asking about. The aortic valve repair is quite different than mitral valve repair. Mitral valve repair is much more successful. Aortic valve repair is still in its infancy and you need to go to a high volume center that does many of them to be successful.
You always want to repair a valve (much less complicated), but there may be reasons to replace, I would need much more information to give an accurate answer.
