Mitral valve repair
Heart surgery that fixes a leaky or faulty mitral valve using your own valve tissue, rather than replacing it, so the valve seals properly again.
✓ Medically reviewed by a GMC-registered consultant · last reviewed September 2026 · next review September 2027 · how we review
In short
- Repair fixes your own leaky or faulty mitral valve so it seals properly, rather than replacing it with an artificial valve.
- When a valve can be repaired, repair is usually preferred over replacement, and most people avoid lifelong blood thinners.
- Not every valve can be repaired, so ask how likely repair is and what happens if replacement is needed during surgery.
- This is open-heart surgery (sometimes minimally invasive); most people stay about a week and take weeks to months to recover.
A plain-English summary. The detail — including risks and recovery — is below.
At a glance
A general guide. Your surgeon will give you advice for your situation.
Often relieves breathlessness and tiredness caused by the leaking valve
The leak is mild or not causing problems, so monitoring may be safer than surgery now.
You are cared for in intensive care or a high-dependency unit, with close monitoring, drains and lines that are removed as you stabilise.
A named contact and clear out-of-hours route for chest, breathing, rhythm or wound problems.
You are cared for in intensive care or a high-dependency unit, with close monitoring, drains and lines that are...
You move to a ward, start getting up and walking, and do gentle breathing exercises. Most people go home around a...
Tiredness is normal and the chest feels tight. Avoid heavy lifting, pushing and pulling to protect the healing...
Energy returns and many people resume light work and most activities, sooner after minimally invasive surgery...
What is mitral valve repair?
The mitral valve is the one-way door between the heart's two left chambers. If it does not seal properly, blood leaks backwards (mitral regurgitation), making the heart work harder and often causing breathlessness and tiredness. Less commonly the valve becomes narrowed.
Mitral valve repair fixes your own valve so it seals again — for example by reshaping or reinforcing it with a supporting ring (annuloplasty) and adjusting the valve's flaps and cords. The aim is to keep your natural valve rather than replace it.
When a leaky mitral valve can be repaired, repair is usually preferred over replacement: people often keep better heart function, avoid lifelong blood thinners and tend to do well long term. Not every valve can be repaired, though, so the surgeon will explain whether repair is likely for you, and what they will do if repair is not possible during the operation.
This is open-heart surgery, sometimes through smaller incisions, and recovery takes time. The decision to operate, and the timing, should be made with a heart team.
Types & techniques
There isn't one single operation. The right approach depends on you — which is something to discuss with your surgeon.
Mitral valve repair vs replacement
| Point | Repair | Replacement |
|---|---|---|
| Your own valve | Kept and reshaped | Removed and replaced |
| Blood thinners | Often not needed long term | Lifelong if mechanical valve |
| Heart function | Often better preserved | Can be slightly less well preserved |
| Suitability | Depends on the valve being repairable | Used when repair is not possible |
Repair is usually preferred when the valve can be fixed, but the final decision is sometimes only confirmed during the operation. Your surgeon should explain both possibilities beforehand.
Preparing for your surgery
- Meet the operating surgeon and anaesthetist, who explain whether repair is likely, the plan if it is not, and your personal risks.
- Expect tests such as an echocardiogram (sometimes a more detailed scan through the gullet), ECG, blood tests and often a coronary angiogram.
- Ask about the surgeon's and centre's experience with mitral repair, as repair rates are higher in specialist hands.
- Tell the team about all medicines and supplements; blood thinners and some others need adjusting beforehand.
- Have a dental check, as treating dental infection first lowers the risk of a valve infection.
- Stop smoking as far ahead as possible to reduce wound, lung and healing problems.
- Arrange help at home and someone to drive you for several weeks.
What happens
The operation is done under general anaesthetic. In standard surgery the surgeon reaches the heart through a cut down the centre of the chest, dividing the breastbone; in minimally invasive surgery, smaller cuts are used, often on the right side of the chest.
A heart-lung machine takes over the work of the heart and lungs, the heart is stopped, and the surgeon repairs the valve — typically reshaping the flaps and cords and fitting a supporting ring. The repair is then tested. If the valve cannot be made to seal reliably, the surgeon may need to replace it instead, which is why this is discussed beforehand.
The chest is closed (the breastbone with permanent wires) and the operation usually takes several hours. You wake up in intensive care or a high-dependency unit with monitoring, drains and lines that are removed over the following days.
Is this operation right for me?
A good consultation should explore whether it's the right choice for you now — including reasons to wait or consider something else.
May not be suitable if…
- The leak is mild or not causing problems, so monitoring may be safer than surgery now.
- You are too frail or unwell for open-heart surgery, where a transcatheter clip (TEER) or medical management may be considered.
- The valve is unlikely to be repairable, so replacement (with its own trade-offs) may be needed.
- Severe other illness means the risks of surgery outweigh the likely benefit.
Delay surgery if…
- You have an active infection, including dental infection, that should be treated first.
- The leak is not yet severe and there is time to confirm severity and timing.
- Important results are missing, such as a detailed echocardiogram of the valve.
- Blood thinners or other medicines need safe adjustment before surgery.
- You need time to stop smoking or optimise other conditions.
Alternatives to discuss
- Mitral valve replacement if the valve cannot be reliably repaired.
- Transcatheter edge-to-edge repair (a clip) for selected higher-risk patients.
- Careful monitoring with echocardiograms if the leak is not yet severe.
- Medicines to manage symptoms, though they do not fix the valve.
- A second opinion or heart-team review, ideally including a surgeon experienced in mitral repair.
Before you decide
Use this as a shared-decision checklist. The aim is not just “can this be done?”, but whether it is right for you, now, with the risks and alternatives clearly understood.
What matters most to me?
Think about symptoms, daily life, work, caring responsibilities, sport, fertility, travel, appearance and anxiety — the right choice depends on your priorities, not just the medical facts.
What are all my options?
Ask about waiting, monitoring, medicines, rehabilitation, a smaller or larger procedure, a different test, NHS referral, or a second opinion where that would help.
What would make me pause?
Active infection, pregnancy, unstable medical problems, smoking, medicines that increase bleeding, poor support at home, or feeling pressured are all reasons to slow down and get tailored advice.
What happens if I do nothing today?
For some problems, waiting is safe; for others, delay can make treatment harder. A good consultation should explain the trade-off in plain English.
Anaesthetic choices
The safest option depends on the operation, your health, the facility and your surgeon/anaesthetist. Ask what is planned and why.
Benefits
- Often relieves breathlessness and tiredness caused by the leaking valve
- Keeps your own valve, which usually preserves heart function well
- Usually avoids the need for lifelong blood thinners (unlike a mechanical valve)
- Can protect the heart from further damage caused by long-standing leakage
- Repaired valves tend to be durable, with low rates of further surgery over many years
Risks & complications
- Tiredness, low mood and poor appetite for several weeks
- Chest-wound pain and tightness as the breastbone or chest heals
- An irregular heartbeat (often atrial fibrillation) in the first days
- Temporary problems with memory and concentration
- Wound or chest infection
- Bleeding needing a return to theatre or a blood transfusion
- A heart-rhythm problem needing a permanent pacemaker
- A temporary effect on kidney function
- Some leak remaining, or returning over time, sometimes needing further treatment
- Needing the valve to be replaced rather than repaired during the operation
- Stroke during or soon after the operation
- Infection of the repaired valve (endocarditis)
- Death — uncommon for planned isolated mitral repair, but a real risk that rises with age and other illness
The main risks to weigh are stroke, bleeding, rhythm problems needing a pacemaker, a remaining or returning leak, and rarely death — and they rise with age, frailty, heart function and other illness. Mitral repair is very surgeon-dependent, so ask how often this surgeon and centre achieve a repair (rather than replacement), and ask for your own estimated risk.
Published figures to discuss
Risk after mitral valve repair varies with age, frailty, heart function and other illness, and outcomes depend strongly on how often the surgeon and centre perform these operations. UK results are audited nationally. The figures below are general ranges for planned isolated mitral repair; your personal risk and the centre's repair rate should be discussed with you. Combined operations carry higher risk.
| Figure | Reported range | How to interpret it | Source / confidence |
|---|---|---|---|
| Need for further mitral surgery over time | Low after repair for degenerative disease — often only a few percent at 10–20 years in experienced centres | One large series reported reoperation of about 4–6% at 10–20 years; durability depends on the cause of the leak and the surgeon's experience. | Durability of mitral valve repair for degenerative disease — PMCpmc.ncbi.nlm.nih.govPublished figure |
| Recurrent leak over time | A minority develop moderate-or-worse leak again over 10 years | Repair does not stop the valve ageing; long-term echocardiogram follow-up is needed. | Guide sourcesClinical context |
| Death from planned isolated mitral repair | Low on average in experienced UK centres, in the low single figures of percent | UK outcomes are audited nationally; risk rises with age, poor heart function and combined operations. | Durability of mitral valve repair for degenerative disease — PMCpmc.ncbi.nlm.nih.govSource-linked context |
These are literature figures, not a personalised prediction. Your own risks and likely benefits depend on your circumstances, your health, and how your care is carried out and followed up.
Recovery — what to expect, and when
Recovery is gradual because the breastbone (or chest) needs time to heal. Most people take about 2–3 months to recover fully after open surgery; minimally invasive surgery can be quicker, often around 6 weeks.
- Feeling drained or emotional for the first few weeks
- A tight, sore or numb feeling along the chest wound
- Disturbed sleep and a reduced appetite early on
- Clicking or aching in the breastbone that eases as it heals
- Gradually noticing less breathlessness as the heart adjusts
Aftercare
- Take all medicines as prescribed, including any short-term blood thinner your team advises.
- Keep wounds clean and dry and watch for signs of infection.
- Build up walking gradually rather than resting completely.
- Avoid heavy lifting, pushing and pulling for about 3 months while the chest heals.
- Do not drive until your team and the driving authority's rules allow (usually at least 4 weeks) — that is the DVLA in England, Scotland and Wales, or the DVA in Northern Ireland.
- Tell any dentist or doctor you have had valve surgery, as you may need antibiotics for some procedures.
- Attend cardiac rehabilitation and keep follow-up appointments, including echocardiograms.
- Someone to drive you home and help for the first days
- A supply of your medicines and a clear list
- Loose, comfortable clothing that does not press on the chest wound
- A cushion to hold against your chest when coughing
- Help arranged with shopping, cooking and chores for several weeks
- An alert note that you have had heart valve surgery
- Clinic and out-of-hours contact numbers saved
Scars and how they heal
You will have a scar down the centre of the chest if the breastbone was opened, or smaller scars, often on the right side of the chest, after minimally invasive surgery. Scars are firm and pink at first and usually fade over many months. Protecting them from strong sun while healing helps them settle.
⚠ Get urgent help if…
- Signs of stroke — face drooping, arm weakness or slurred speech — call 999 immediately
- Sudden or worsening breathlessness, or fainting
- Chest pain that does not settle
- A wound that is increasingly red, hot, swollen or leaking, or a clicking, unstable breastbone
- Fever or feeling generally unwell, which can signal a valve or wound infection
- A fast or very irregular heartbeat with dizziness
- A hot, swollen, painful calf, which can signal a clot
Who to contact: your surgeon or clinic first (keep their number to hand). For urgent advice when you can't reach them, call NHS 111. In an emergency, call 999.
General guidance — it doesn't replace the specific advice your surgeon gives you.
Results & realistic expectations
A successful mitral repair stops or greatly reduces the leak, so the heart no longer has to pump the same blood twice. Many people notice less breathlessness and more energy as they recover, and keeping your own valve usually preserves heart function well.
Repair does not stop the underlying valve from ageing, and a small number of people develop a leak again over the years. Operating before the heart is badly strained gives the best chance of a lasting result, which is one reason timing and specialist assessment matter.
Repaired mitral valves tend to be durable. In people with degenerative (wear-related) leakage, the chance of needing further mitral surgery is low for many years — often only a few percent at 10–20 years in experienced centres — though some people develop a recurrent leak over time. Durability depends on the cause of the leak, how the valve was repaired and the surgeon's experience, so results are best in centres that do many of these operations.
Combining with other procedures
Mitral valve repair is sometimes done in the same operation as a coronary artery bypass, surgery on another valve, or a procedure to treat atrial fibrillation, if these problems are present. Combining procedures increases the size and risk of the operation, so the heart team will discuss whether doing everything at once is right for you.
Follow-up & long-term care
You will usually be reviewed in the weeks after surgery to check your wounds, rhythm and recovery, with cardiac rehabilitation alongside. Longer term you will have periodic checks including echocardiograms to confirm the repair is holding, often shared between your cardiologist and surgeon.
- Good dental care and telling clinicians you have had valve surgery, to reduce infection risk
- Periodic echocardiograms to check the repair over time
- Taking any prescribed medicines, including a short-term blood thinner if advised
- Managing blood pressure and other heart risk factors
- Prompt review if breathlessness or tiredness returns
Revision and secondary surgery reality
- A small number of people develop a recurrent leak and may need further surgery over the years.
- Repeat (redo) mitral surgery is harder and carries higher risk than the first operation.
- Some recurrent leaks can be managed with a transcatheter clip rather than open surgery.
- Choosing an experienced mitral-repair surgeon improves both repair rate and durability.
Ask your surgeon for their own revision rate, what counts as a revision, and what is included in the written aftercare policy.
What good aftercare looks like
- A named contact and clear out-of-hours route for chest, breathing, rhythm or wound problems.
- A structured cardiac rehabilitation programme.
- Planned echocardiogram follow-up to confirm the repair is holding.
- Advice on dental care and antibiotic cover to reduce valve-infection risk.
- Clear medicine instructions, including any short-term blood thinner.
What affects the cost
Costs vary a great deal between people and providers, and we don't publish prices. What matters is understanding what drives the cost and making sure your quote is complete. The main things that affect it:
- Surgeon's and anaesthetist's fees, and surgeon experience with mitral repair
- Operating theatre, perfusion (heart-lung machine) and intensive-care time
- Whether surgery is open or minimally invasive, and any supporting ring/device used
- Whether other procedures (such as a bypass or rhythm surgery) are combined
- Length of hospital and intensive-care stay, longer if complications occur
- Pre-operative tests, including detailed echocardiography
- Cardiac rehabilitation and follow-up echocardiograms
- The surgeon's and anaesthetist's fees
- Theatre, perfusion and intensive-care charges
- Any ring or device cost, and what is included if replacement is needed instead
- Pre-operative tests and assessments
- Expected hospital length of stay and the cost of extra days
- Follow-up appointments and echocardiograms
- What happens, and who pays, if there is a complication, longer stay or readmission
On the NHS? Mitral valve repair is commonly provided by the NHS when clinically indicated; private care is mainly used for choice of surgeon, hospital or timing rather than a different operation.
You're entitled to your total cost in writing — including aftercare and any revision — before you decide.
Consent traps and marketing red flags
These are not small details. They are often where patients lose choice, time to reflect, or realistic expectations.
Consent traps
- Not being told how likely a repair (rather than replacement) really is in your case.
- No clear plan, or consent, for what happens if repair is not possible during surgery.
- Risks of stroke, pacemaker, bleeding and death not given as your personal estimate.
- The surgeon's or centre's repair rate and experience not discussed.
- No written aftercare, dental-care and warning-signs plan before discharge.
Marketing red flags
- Guaranteeing a repair before the valve has been fully assessed or even seen at operation.
- Describing open-heart surgery as 'routine' or 'low risk' without your own figures.
- Promising a 'permanent' fix without mentioning that valves age and leaks can recur.
- Pushing keyhole surgery as best for everyone, regardless of the valve problem.
Choosing a surgeon safely
- Check your surgeon is on the GMC Specialist Register for this area.
- Make sure they practise at a CQC-registered location, and look for membership of bodies like BAAPS or BAPRAS.
- You're entitled to a two-stage consent process with time to reflect (a cooling-off period). The surgeon who will operate must consent you — not a salesperson.
- Be wary of pressure: time-limited offers, discounts or deposits taken before you've had time to think are red flags, not bargains.
- You're entitled to your total cost in writing — including aftercare and any revision — before you decide.
Questions to ask your medical professional
Take this to your consultation. A good surgeon will welcome every one of these.
- How likely is it that my valve can be repaired rather than replaced?
- What will you do if a reliable repair is not possible during the operation?
- How many mitral repairs do you and this centre do each year, and what is your repair rate?
- Could I have minimally invasive surgery, and would it suit me?
- What is my personal estimated risk of stroke, pacemaker, bleeding and death?
- How will the repair be checked over the years, and what if the leak comes back?
- Are you on the GMC Specialist Register for this area, and which Royal College or professional body are you a member of?
- Will you be the surgeon who carries out my operation, and who looks after me afterwards?
- What are the risks for someone like me, and how often do your own patients have a problem or need it repeated or redone?
- What does a realistic result look like — and what can this operation not achieve?
- What are my options, including waiting, doing nothing for now, or choosing a different approach?
- Can I have written information, results and aftercare instructions in a format I can use, including any accessibility or communication support I need?
- What is the total cost in writing, including any follow-ups, and how much time do I have to decide?
Frequently asked questions
Is repair better than replacement?
What if my valve can't be repaired?
Will I need blood thinners?
How long is the recovery?
Does the surgeon's experience matter?
Is this available on the NHS?
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How we made this page
Medically reviewed by a GMC-registered consultant. Written in plain English, checked against NHS, NICE, GMC and relevant Royal College / specialist-society guidance, and kept under review. No clinic paid to appear on this page, and we publish no pricing. This is general information to help you prepare — it is not a substitute for advice from your own clinician. How we review our guides →
Source hierarchy: UK regulator and NHS/NICE guidance first, then relevant Royal College or specialist-society guidance, then peer-reviewed evidence for procedure-specific figures where available.
Sources & standards: British Heart Foundation — Heart valve repair surgery NHS — How a heart valve replacement is done NICE NG208 — Heart valve disease in adults NICE IPG245 — Keyhole surgery to repair a mitral valve Durability of mitral valve repair for degenerative disease — PMC DVLA — Assessing fitness to drive (Great Britain) DVA Northern Ireland — Telling DVA about a driver medical condition
Reviews reflect patients' experience of care, not clinical outcomes. For procedure volumes and outcome data see PHIN.
Last medically reviewed 2026-09-21. Spotted something wrong or out of date? Report an error in this guide.
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