Surgeon Q&A: Why Do Mitral Valves Need to Be Re-Repaired?

Patients who undergo mitral valve repair surgery typically understand that there are no guarantees of never having to return to the operating room for a re-repair. Although research suggest that less than 5% percent of patients will experience regurgitation severe enough to need re-repair surgery, it doesn’t lessen the anxiety before each yearly echocardiogram. For this reason, a common question we receive from patients is, “What are the reasons a mitral valve re-repair is needed?”

Adam Pick, the founder of HeartValveSurgery.com, met with Dr. Marc Gillinov for an answer to this important question. Dr. Gillinov is the Chairman of Cardiac Surgery at the Cleveland Clinic in Cleveland, Ohio. He is an expert in mitral valve surgery, and according to the Cleveland Clinic, Dr. Gillinov does more mitral valve surgeries every year than any other surgeon in the world!

Facts About Mitral Valve Re-Repair

Here are the key insights shared by Dr. Gillinov:

• Minimal leakage after a mitral valve repair is normal but progression can be concerning. “This can happen from time to time that somebody gets a valve repair, and it looks great, but then over time the valve begins to leak again,” explained Dr. Gillinov. “Leaking equals regurgitation, and we use those two terms interchangeably. All mitral valves leak a little bit, but if the leak is moderate or more, we consider that concerning. If someone undergoes a valve repair today and five years down the road, their echocardiogram report indicates a moderate leak; several things may have happened to the valve.

• There are different reasons why a valve may start leaking again. “Several things might have happened to the valve,” said Dr. Gillinov. “It can be something else in the valve breaks. Maybe the surgeon fixed one part at six o’clock. If the valve were a clock face, six o’clock looks good, but nine o’clock broke. Just like your car, sometimes you get one thing fixed, only to need maintenance on something else. Another thing that could happen is that it can be an infection, also called endocarditis. At other times, there may be a technical failure, such as a suture break, or excessive scar tissue can form. For instance, someone gets a cut on their hand, and it makes a big scar. The same thing can happen with the valve. You can get too much scar tissue.”

• A new mitral valve leak doesn’t always progress. “If you have a valve that’s started to leak again, which is relatively uncommon, first and foremost, don’t panic. Moderate leaks often don’t progress, and you’ll just need to continue getting an echo once a year.

• More severe leaking may need intervention. “Let’s say 10 years down the road, it’s really leaking. Now what? You’re going to need something to fix the valve, and the most common solution is to re-repair it. We can usually go back in, sometimes robotically, sometimes endoscopically, and sometimes with a regular sternal incision. More often than not, we can re-fix the valve, but sometimes it may need to be replaced.

• There are a few non-surgical options. “There is a non-surgical option termed Transcatheter Edge to Edge Repair or ‘TEER.’ There are also two devices in the United States called the MitraClip and the Pascal device, which can be used to repair a valve non-surgically. They’re not well tested in this setting, where a valve is leaking after a previous operation, but occasionally it is a nice way to get out of the situation without surgery.”

• Patients should not change what they are doing. Dr. Gillinov emphasized that the most important message is to undergo an echocardiogram (echo) every year after a valve repair. “If you develop a small or moderate leak, keep getting an echo every year, go on with your life, exercise, eat right, and do whatever you want to do. If the valve leak becomes more than moderate or severe, we will need to fix it. The first option would be a surgical team that is skilled and has experience with re-repair. It’s possible you need a replacement, and a distant third would be maybe we can fix it without surgery.”

Thanks Dr. Gillinov and Cleveland Clinic!

On behalf of all the patients in our community, many thanks to Dr. Marc Gillinov, for everything you and your team are doing at the Cleveland Clinic in Cleveland, Ohio!

Related links:

• Gillinov’s Mitral Valve Succes Story: Suzi Epstein
• Patient Webinar: Watch 3 Questions to Ask Before Mitral Valve Surgery with Dr. Gillinov
• Surgeon Q&A: Timing Mitral Valve Repair Surgey with Dr. Gillinov

Keep on tickin,
Adam

P.S. For the deaf and hard-of-hearing members of our patient community, we have provided a written transcript of our interview with Dr. Gillinov below.