Sometimes, the most appropriate treatment is a nonsurgical approach that involves medications, lifestyle changes and monitoring.

Our heart failure cardiologists often use this approach in patients with secondary mitral valve disease (caused by other heart conditions). With expert management of their medications, many patients feel better and don’t need additional treatment.

Most of the transcatheter approaches are in clinical trials and approved for people who are unable to tolerate open-heart surgery. Some treatments are now available for low-risk patients through clinical trials offered at Frankel Cardiovascular Center.

Transcatheter techniques use catheters (thin tubes) to reach the heart. Catheter-based treatments don’t require surgery and large incisions, which leads to a shorter hospital stay, less pain and quicker recovery.

Our doctors use different entry points for catheter-based mitral valve treatment, including the groin and chest. Procedures that use catheters inserted through the groin include:

• Mitral valve balloon valvuloplasty: In patients with less severe stenosis, the doctor inflates a balloon inside the damaged valve. This opens the valve and restores blood flow.
• Transcatheter mitral valve repair: This procedure is used in patients with mitral valve regurgitation who are not candidates for open-heart surgery. The doctor inserts a clip to hold together a small area of the mitral valve. This allows blood to flow on either side of the clip when the valve is open but reduces backflow when the valve closes.
• Chord replacement: Chords are fibers that support the mitral valve and prevent prolapse. The doctor attaches new chords to prolapsed sections of the leaflets and secures them to the ventricle wall.

Some procedures require a larger catheter inserted through a small incision on the left side of the chest. Our doctor guides the catheter through the tip (apex) of the heart into the left ventricle. Several clinical trials are available that use this approach for:

• Valve replacement: The doctor delivers a collapsible replacement valve through the catheter, expands it in place and ensures a good fit. If needed, the valve can be repositioned or removed. A tether connected to the valve is attached to the bottom of the ventricle to provide support. Clinical trials for mitral valve replacement using smaller valves inserted through the groin will be available at Frankel Cardiovascular Center soon.

At the Frankel Cardiovascular Center, we have established a team of experts skilled in transcatheter approaches. We call this the MATRIx team (Mitral and Tricuspid Intervention team). They evaluate patients to determine if they are candidates for transcatheter approaches and coordinate their care.

Our doctors often use a minimally invasive surgical approach to repair or replace the mitral valve. During this type of surgery, the doctor accesses the heart through an incision between the ribs (thoracotomy).

The surgical team stops the heartbeat while a heart-lung machine continues to circulate blood to the body. The doctor replaces or repairs the valve and performs other surgical procedures as needed. The team then restarts the heart, restores blood flow and closes the incision.

In some cases, we recommend open-heart surgery for patients with severe mitral prolapse or multiple heart conditions, or for those who have had previous operations.

During open-heart surgery, the doctor makes an incision in your breastbone and opens your chest. The procedure, called a sternotomy, allows the doctor direct access to your heart and mitral valve. The surgical team stops the heartbeat while maintaining blood flow to the body using a heart-lung machine.

Our surgical teams are among the best in the country. We perform a high volume of complex surgical procedures and have excellent outcomes.

Mitral valve disease frequently occurs with other heart and valve conditions. For example, 30% to 40% of patients with mitral valve disease have atrial fibrillation (irregular heartbeat). It is also common to have both mitral valve and tricuspid valve disease.

Our doctors combine treatments, using minimally invasive approaches as much as possible. At the Frankel Cardiovascular Center, we have experts in all types of cardiovascular conditions. They work together to address all your heart conditions and reduce the need for multiple surgeries.