Mitral Valve Treatments

Reviewed by Columbia Structural Heart and Valve Center Faculty, July 2024

At a Glance

Mitral valve disease is the most common form of heart disease, but until recently, treatments were limited to medications and open-heart surgery.
New minimally invasive transcatheter treatments can treat mitral valve disease by accessing the heart through a blood vessel in the leg or neck.
Technological advances like robotic surgery can treat patients that otherwise would not be candidates for traditional surgery.

What is the Mitral Valve?

The mitral valve controls blood flow from the left atrium to the left ventricle of your heart. It has two leaflets (flaps), while other heart valves typically have three.

What is Mitral Valve Disease?

Mitral valve disease keeps the valve from properly managing blood flow.

Mitral Regurgitation (MR) or Mitral Insufficiency: The mitral valve cannot fully close, or the leaflets are too loose (prolapse), causing blood to flow backward into the left atrium. This reversed flow can cause can cause the heart to enlarge and eventually fail if left untreated.
Mitral Stenosis (MS): The mitral valve stiffens and narrows. Blood backs up into the lung and can result in progressive lung and heart failure.
Mitral Annulus Calcification (MAC): When calcium builds up on the fibrous ring (annulus) at the base of the mitral valve, it can contribute to mitral valve dysfunction, and make symptoms for MR and MS worse.

Mitral valve disease is the most common form of heart valve disease. This disease is often accompanied by other health conditions (comorbidities), including valve disease in other heart valves, or heart rhythm problems (arrhythmias). If left untreated, mitral valve disease can significantly impact quality of life and can lead to heart failure and death.

How is Mitral Valve Disease Treated?

Treatments for mitral valve disease are rapidly expanding, with new research and technologies driving improvements to existing procedures and exploring new devices and minimally invasive strategies for repair and replacement.

Medications

Medications are first-line therapy to address symptoms and help the heart pump better. These medications include:

Antiarrhythmics
Beta blockers
Blood thinners
Diuretics

Transcatheter Treatments (Interventional Cardiology)

These minimally invasive procedures can access the heart through the large blood vessels without traditional surgery.

Advanced cardiac imaging technology is used to guide the procedure, allowing the team to “see” the structures of the heart and circulatory system.
A guidewire is inserted into a blood vessel in the leg or neck and then guided up to the heart.
A special tube called a catheter then delivers instruments and devices up to the diseased valve.
Once in place, the devices are deployed and implanted.
Once completed, the instruments and wires are removed, and the catheter is withdrawn.

Transcatheter procedures are good options for patients who are too sick or frail for traditional surgery. They also offer several benefits over surgery, including:

Shorter procedure time and hospital stays
Fewer complications
Faster recovery
Less pain

Transcatheter treatments include:

Transcatheter Valve Repair
- Transcatheter edge-to-edge repair (TEER)
  - A device with grasping arms is inserted into the mitral valve.
  - The arms grab onto the leaflets of the valve and pull them together at the center.
  - This new valve closure creates two smaller openings that open and close more effectively, reducing or eliminating mitral regurgitation.
  MitralClip and Pascal Mitral Valve Repair Systems
  Columbia developed the MitraClip device. We are now a major center for both the MitralCip and Pascal Mitral Valve repair systems, and are actively exploring new devices and technologies for treating MR.

Transcatheter Electrosurgery - This procedure uses an electrical current to cut and reshape valve leaflets and other cardiac tissue without the need for open-heart surgery.
Transcatheter Mitral Valve Replacement
- A replacement valve is guided through the catheter to the mitral valve.
- The valve is deployed, expanded, and implanted in the diseased valve or failed replacement mitral valve.
- Once completed, the wire and catheter are withdrawn.
  Intrepid TMVR at Columbia
  As lead investigators for the APOLLO clinical trial, Columbia is one of only a handful of centers in the nation to offer the Intrepid transcatheter mitral valve replacement system (TMVR), which can replace the mitral valve without open-heart surgery.

Surgery

The mitral valve can also be repaired or replaced using traditional open surgery with general anesthesia. The heart is accessed directly through either a large chest incision (sternotomy) or through a smaller incision in the chest. The type of surgery performed will depend on the type and severity of the valve disease.

Robotic Valve Surgery

Robotic surgery uses a highly advanced surgical platform (robot) with articulating arms and instruments to perform complex surgeries. Guided by the surgeon working at a console, surgical robots can be used to perform valve surgery and other procedures through very small incisions with a very high level of precision.

Types of mitral valve surgery include:

Mitral Valve Repair - The valve’s leaflets are reshaped or separated. A ring may also be implanted to restore the shape or tighten the base of the valve (annuloplasty).
Mitral Valve Replacement - The damaged valve is surgically removed and replaced with a mechanical or biological tissue valve.

How Long Does Recovery Take?

Recovery from mitral valve treatment will vary based on several factors, including:

The type of treatment
The severity of disease
Additional heart conditions
Previous surgeries
Age
Overall health

Patients may also take medications after treatment to avoid infections and reduce the risk of vascular complications like stroke.

How Long Does a Replacement Valve Last?

Replacement valves can last as long as 30 years, and new valve types are being designed to last even longer. The type of valve used will often depend on the age of the recipient; for example, current mechanical valves will last longer than valves made with biological material (animal or human tissue), so mechanical valves may be a better choice for younger recipients.

If a replacement valve starts to fail, it may be possible to implant another replacement valve within the failing valve (valve-in-valve technique).

Transcatheter valves are a relatively new technology, and are currently being studied in higher surgical risk patients. Long term studies are underway to understand how long these valves last and to measure their effectiveness over time.

Next Steps

Mitral Valve Disease can have a significant impact on your overall health and quality of life, and getting treated is just part of the plan. Mitral valve disease is often found with other types of heart valve disease, and can lead to serious health problems like heart failure and stroke. So, it’s essential to work with your cardiologist and valve care team to monitor and manage your long-term heart health.

Columbia is a world leader for heart valve care, with the expertise and experience to support your needs for years to come. To learn more about partnering with the Columbia Structural Heart and Valve Center for your care, call us at (212) 342-0444 or complete our online appointment application form.

We accept most major insurance plans and can verify your plan when you call to make your appointment.