The gold standard for the treatment of degenerative mitral valve regurgitation has always been open heart surgery but guidelines for when a patient should undergo surgery have changed significantly over the last decade. In the past, if a patient had severe mitral valve regurgitation but no symptoms, the recommendation was “watchful waiting.” Many physicians now feel that if a patient waits until symptoms appear is too late because harmful changes to the heart may have already occurred. If surgery is recommended, patients with impaired heart function may experience more complications, especially those with advanced age. In rare instances, some asymptomatic patients may experience sudden death, most likely caused by arrhythmias. The authors of a recent study argue in favor of early surgery when the chances of success are greatest, instead of waiting for symptoms to occur. American Heart Association guidelines recommend that asymptomatic patients with severe 

mitral valve regurgitation undergo surgery if the surgeon believes there is a high probability of repairing the mitral valve successfully. 

 

Surgical options for mitral valve regurgitation can be grouped into two broad categories: repair and replacement. There are a number of different repair techniques but mitral valve replacement procedures involve either a prosthetic or mechanical valve. Mitral valve repair operations have a lower operative mortality, lower risk of stroke, lower risk of infection and superior long-term survival rates which is why mitral valve repair it is widely accepted as the preferred treatment option for degenerative mitral valve disease. Additionally, replacement patients who receive a mechanical valve must take anticoagulation medication for the rest of their lives and patients who receive a prosthetic valve will need an additional operation to replace the valve when it fails.

 

The traditional mitral valve repair technique is known as a resectional repair where a portion of the prolapsed leaflet is removed and the leaflet is stitched back together. A newer repair technique that has been gaining popularity over the last twenty years involves replacing the stretched or broken chordae without resecting the prolapsed leaflet. Damaged or ruptured chordae are replaced with ePTFE suture material. Sutures are anchored in the papillary muscle and then placed through the edge of the prolapsed leaflet. When the suture is tightened, the prolapsed portion of the leaflet returns to its normal position and the leaflets once again fit together. The advantage to this technique is that it preserves the natural leaflet tissue, and usually results in a larger area of coaptation between the leaflets. By not resecting the valve, the original anatomy of the valve is preserved.