Mitral valve replacement
Open-heart surgery to replace a faulty mitral valve with a mechanical or tissue valve, used when the valve is too damaged to repair.
✓ Medically reviewed by a GMC-registered consultant · last reviewed September 2026 · next review September 2027 · how we review
In short
- It replaces a badly leaking or narrowed mitral valve that cannot be repaired, so blood flows in one direction again.
- Where possible, surgeons prefer to repair the mitral valve; replacement is used when repair is not reliable.
- The key choice is mechanical (very durable but lifelong blood thinners) versus tissue (usually no lifelong blood thinners but may wear out).
- This is open-heart surgery; 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.
Relieves the strain a badly leaking or narrowed valve puts on the heart and lungs
Your valve could be repaired instead, which is usually preferred where possible.
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. Cardiac rehabilitation helps you rebuild...
What is a mitral valve replacement?
The mitral valve is the one-way door between the heart's two left chambers. If it leaks badly (mitral regurgitation) or becomes narrowed (mitral stenosis) and cannot be repaired, it may need replacing with an artificial valve so blood flows in one direction again.
This is open-heart surgery: the surgeon usually opens the breastbone and uses a heart-lung machine to take over while the heart is stopped and the new valve is sewn in. Some people are suitable for a smaller-incision (minimally invasive) approach.
When a mitral valve can be repaired, repair is usually preferred, because people often keep better heart function and avoid lifelong blood thinners. Replacement is used when the valve is too damaged to fix reliably. As with the aortic valve, you choose between a mechanical valve (very durable but needs lifelong blood thinning) and a tissue valve (usually no lifelong blood thinners but tends to wear out and may need replacing).
The decision to operate, the timing, and repair-versus-replacement should all be discussed 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.
Mechanical vs tissue mitral valve
| Point | Mechanical valve | Tissue valve |
|---|---|---|
| Durability | Very long-lasting, rarely wears out | Tends to wear out over time |
| Blood thinners | Lifelong (usually warfarin) with blood tests | Often not needed long term |
| Bleeding risk | Higher, from lifelong blood thinning | Lower |
| Often suits | Younger patients | Older patients, or those who can't take blood thinners |
Neither valve is 'best' for everyone. The choice balances durability against the burden and bleeding risk of lifelong blood thinners, alongside your age and lifestyle.
Preparing for your surgery
- Meet the operating surgeon and anaesthetist, who explain why replacement (rather than repair) is planned, the valve choices and your personal risks.
- Expect tests such as an echocardiogram (sometimes through the gullet), ECG, blood tests and often a coronary angiogram.
- Discuss mechanical versus tissue valve carefully, including how lifelong blood thinners would fit your life.
- 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 removes or reshapes the damaged valve and sews the new valve into place. Surgeons often try to keep parts of your own valve apparatus, which can help heart function.
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 as you recover.
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…
- Your valve could be repaired instead, which is usually preferred where possible.
- The problem is mild or not causing symptoms, so monitoring may be safer than surgery now.
- You are too frail or unwell for open-heart surgery, where other options may be considered.
- A mechanical valve is being considered but you cannot safely take lifelong blood thinners.
Delay surgery if…
- You have an active infection, including dental infection, that should be treated first.
- Symptoms are mild and there is time to confirm severity and the best valve choice.
- 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 repair, which is usually preferred when the valve can be fixed.
- Transcatheter edge-to-edge repair (a clip) for selected higher-risk patients.
- Careful monitoring with echocardiograms if the problem 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
- Relieves the strain a badly leaking or narrowed valve puts on the heart and lungs
- Often improves breathlessness, tiredness and exercise tolerance as you recover
- Restores reliable one-way blood flow through the heart
- A mechanical valve, in particular, is very unlikely to wear out
- Can be the right option when the valve is too damaged to repair
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
- Bleeding problems if you have a mechanical valve and need lifelong blood thinners
- Stroke during or soon after the operation
- Infection of the new valve (endocarditis), which is serious
- A clot forming on a mechanical valve if blood thinning is inadequate
- Death — uncommon for planned isolated valve replacement, but a real risk that rises with age and other illness
The main risks to weigh are stroke, bleeding, rhythm problems needing a pacemaker, valve infection or clot, and rarely death — and they rise with age, frailty, heart function and other illness. If you may receive a mechanical valve, ask how lifelong blood thinning would fit your life. Ask whether repair is genuinely not possible, and for your own estimated risk.
Published figures to discuss
Risk after mitral valve replacement varies with age, frailty, heart function and other illness, so a single figure can mislead. UK outcomes are audited nationally and published by hospital and surgeon. The figures below are general ranges for planned isolated mitral valve replacement; your personal risk should be estimated for you, and combined operations carry higher risk.
| Figure | Reported range | How to interpret it | Source / confidence |
|---|---|---|---|
| Death from planned isolated mitral valve replacement | Low single figures on average; UK audit-era reports commonly cite around 3–4% overall for mitral valve replacement | Mitral valve surgery generally carries somewhat higher risk than isolated aortic valve replacement; UK results are audited nationally (NICOR/SCTS). | ACC — Pacemaker implantation after valve surgeryacc.orgPublished figure |
| Stroke around the time of surgery | Roughly 1–2% on average, higher with older age and arterial disease | Ask your surgeon for your individual estimate. | ACC — Pacemaker implantation after valve surgeryacc.orgPublished figure |
| Need for a permanent pacemaker | About 10.5% within 1 year after mitral valve replacement in one large valve-surgery database; lower after mitral repair | Risk is higher with age, pre-existing conduction disease, arrhythmias and combined valve/bypass/ablation surgery; ask for the local figure. | ACC — Pacemaker implantation after valve surgeryacc.orgPublished figure |
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
- Hearing a faint clicking from a mechanical valve, which is normal
Aftercare
- Take all medicines as prescribed; if you have a mechanical valve, never miss your blood thinner and attend monitoring.
- 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 official driving rules allow — these are set by DVLA in England, Scotland and Wales, and by DVA in Northern Ireland (usually at least 4 weeks).
- Tell any dentist or doctor you have a replacement valve, 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, if relevant, your blood-thinner monitoring plan
- 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 card or note that you have a replacement heart valve
- 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
- Unusual bruising, or bleeding that won't stop, if you take blood thinners
- A fast or very irregular heartbeat with dizziness
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 valve replacement restores reliable one-way blood flow and relieves the strain a faulty valve puts on the heart and lungs. Many people notice less breathlessness and more energy as they recover.
The operation does not make the heart young again, and some changes from long-standing valve disease may not fully reverse. A tissue valve will tend to wear over time, and any replacement valve carries a small ongoing risk of infection or, for mechanical valves, clot if blood thinning is inadequate — so lifelong follow-up, dental care and (for mechanical valves) reliable blood thinning matter.
A mechanical mitral valve is very unlikely to wear out and can last decades, but the trade-off is lifelong blood thinning. A tissue valve typically lasts a number of years before it may need replacing, and tends to wear faster in younger people. A worn tissue valve can sometimes be treated with a catheter valve-in-valve in selected cases. Your surgeon will explain what is realistic for your age and valve choice.
Combining with other procedures
Mitral valve replacement is sometimes done in the same operation as a coronary artery bypass, surgery on another valve, or a procedure to treat atrial fibrillation. 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 watch the valve, and if you have a mechanical valve, regular blood-thinner monitoring for life.
- Lifelong blood-thinning medicine and regular blood tests if you have a mechanical valve
- Good dental care and telling clinicians you have a replacement valve, to reduce infection risk
- Periodic echocardiograms to check the valve, especially a tissue valve over time
- Managing blood pressure and other heart risk factors
- Prompt review if breathlessness, tiredness or fainting returns
Revision and secondary surgery reality
- A tissue valve tends to wear over time and may need replacing.
- A worn tissue valve can sometimes be treated with a catheter valve-in-valve rather than repeat open surgery.
- Repeat (redo) mitral surgery is technically harder and carries higher risk than the first operation.
- A mechanical valve rarely wears out, but the trade-off is lifelong blood thinning and a small clot risk if it is inadequate.
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.
- Clear medicine instructions and, for mechanical valves, a reliable blood-thinner monitoring plan.
- Advice on dental care and antibiotic cover to reduce valve-infection risk.
- Planned echocardiogram follow-up to watch the valve over time.
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
- Operating theatre, perfusion (heart-lung machine) and intensive-care time
- The type of valve used (mechanical or tissue)
- Whether surgery is open or minimally invasive, and whether other procedures are combined
- Length of hospital and intensive-care stay, longer if complications occur
- Pre-operative tests and, for mechanical valves, ongoing blood-thinner monitoring
- Cardiac rehabilitation and follow-up echocardiograms
- The surgeon's and anaesthetist's fees
- Theatre, perfusion and intensive-care charges
- The valve (device) cost and which type is included
- Pre-operative tests and assessments
- Expected hospital length of stay and the cost of extra days
- Follow-up appointments, echocardiograms and, if relevant, blood-thinner monitoring
- What happens, and who pays, if there is a complication, longer stay or readmission
On the NHS? Mitral valve replacement 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 whether the valve could have been repaired instead of replaced.
- Valve choice (mechanical vs tissue) decided without a full discussion of the trade-offs for your life.
- Risks of stroke, pacemaker, bleeding and death not given as your personal estimate.
- Lifelong blood thinning and its monitoring not explained before agreeing to a mechanical valve.
- No written aftercare, dental-care and warning-signs plan before discharge.
Marketing red flags
- Describing open-heart valve surgery as 'routine' or 'low risk' without your own figures.
- Recommending replacement without first considering whether repair is possible.
- Steering you toward one valve type without explaining the trade-offs.
- Promising a 'permanent' fix without mentioning tissue-valve wear, clot or infection risk.
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.
- Why is replacement, rather than repair, being recommended for my valve?
- Do you recommend a mechanical or tissue valve for me, and why?
- What is my personal estimated risk of stroke, pacemaker, bleeding and death?
- If I have a mechanical valve, how will lifelong blood thinning be monitored?
- Could I have minimally invasive surgery, and would it suit me?
- What follow-up and valve checks will I need over the years?
- 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
Why replace rather than repair my mitral valve?
Mechanical or tissue valve — which should I choose?
Will I have to take warfarin for life?
How long is the recovery?
Can I hear a mechanical valve?
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: NHS — How a heart valve replacement is done NHS — Complications of a heart valve replacement British Heart Foundation — Heart valve replacement surgery NICE NG208 — Heart valve disease in adults Females have increased short-term mortality after cardiac surgery (UK NACSA) — PMC ACC — Pacemaker implantation after valve surgery DVLA — Assessing fitness to drive 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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