Mitral Valve Surgery: Advising Patients on Options and What to Expect (Podcast)

“If you’ve got a patient who has severe mitral valve regurgitation, the clear advice is to get it fixed,” says Marc Gillinov, MD, Chair of Thoracic and Cardiovascular Surgery at Cleveland Clinic. “The valve is broken, and if you leave it alone, it’s going to shorten the patient’s life. When the patient thinks about getting their valve fixed, they should choose a team that can offer a very high likelihood of valve repair over replacement as well as the option to explore a less-invasive robotic approach to repair.”

Those are the cornerstones of advice Dr. Gillinov and his cardiac surgeon colleague Tarek Malas, MD, share in a recent episode of Cleveland Clinic’s Cardiac Consult podcast focused on how they advise patients about mitral valve surgery before and after the operation. Their discussion covers the following:

• Advantages of valve repair over replacement for mitral valve prolapse and regurgitation
• What to tell patients about lifestyle after mitral valve repair
• Benefits of robotically assisted mitral valve repair for appropriate candidates
• The importance of timely surgery and comprehensive care for mitral valve disease
• How to advise patients about postsurgical recovery and cardiac rehabilitation
• How patient age may affect the repair-versus-replace decision

Click the podcast player above to listen to the 11-minute episode now, or read on for an edited excerpt. Check out more Cardiac Consult episodes at clevelandclinic.org/cardiacconsultpodcast or wherever you get your podcasts.

Excerpt from the podcast

Tarek Malas, MD: The question comes up about the age at which patients should have their mitral valve repaired or replaced. Generally speaking, when patients are younger, we almost always try to repair the valve. At expert centers, repairs are generally better than replacements. In some cases, we can't repair the valve and we have to replace it — for example, in the setting of rheumatic heart disease or infection, or if the valve is just too calcified.

For patients who are older and who have valves that are not repairable, we generally lean more toward replacement. Replacement is still a great option. Generally, we favor a bioprosthetic valve replacement in the majority of older patients because that’s a valve that provides excellent safety, excellent durability and fits very well in that context.

Marc Gillinov, MD: The average age at which people have surgery for mitral valve prolapse is 59 years. We don’t really think of patients as being in an older age group until the mid-70s and beyond. So, if a patient comes in with mitral valve prolapse and they’re 59 or 69 or even 75, we’re still going to be thinking mitral valve repair is at the top of the list.

Now, if the patient is 80, we’ll be looking carefully at their valve. The key there is to have a quick and safe operation. Oftentimes, a repair is the quickest, safest thing to do in an 80-year-old. But if they’re 80 or 85 and they wind up with a pig valve, they’re still going to be much better off than they were with their broken native valve.