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Heart Valve Repair and Replacement

Heart valves are flaps, or leaflets, of tissue that ensure that blood entering or leaving the heart moves in the proper direction, with no backflow. The heart and its great vessels have a total of four valves, the mitral valve, tricuspid valve, aortic valve, and pumonary valve. Valvular disease can affect any of these four valves, and can interfere with the normal flow of blood through the heart. Heart valves that are defective may either be repaired or replaced with a tissue or mechanical substitute, depending on the severity of the condition.

Repair of Heart Valves

One method of heart valve treatment involves restoring the valve to normal function by removing damaged or malformed tissue and surgically reconstructing the valve. An advantage of this method is that the patient's own valve tissues are used, so that long-term anticoagulation is not required. NewYork-Presbyterian's heart surgeons have special expertise in mitral valve repair.

When the leaflets of the mitral valve fail to close properly, blood can backflow into the heart and lungs, resulting in compromised blood flow to the rest of the body. NewYork-Presbyterian surgeons can treat this type of mitral valve defect using a minimally invasive approach that does not require opening the chest or stopping the patient's heart. The "Bow Tie" procedure uses a single stitch to join mitral valve leaflets that do not meet properly when closed. The mitral valve can still open on either side of the stitch allowing for adequate blood flow, and the leaflets are able to close properly when they are supposed to as the heart beats.

Investigational Studies
NewYork-Presbyterian/Weill Cornell and NewYork-Presbyterian/Columbia are conducting investigational studies – through the Everest II Clinical Trial – of a new device for repair of mitral valve leakage. By holding together parts of the leaflets that form an abnormally large opening for the mitral valve, this device helps to prevent backflow of blood from the left ventricle to the left atrium of the heart as it beats. Placement of the investigational device does not require surgery; a catheter is inserted into a peripheral blood vessel, and is guided to the heart where the device is positioned. After ensuring that the correct placement has been achieved, the catheter is removed. The patient remains under general anesthesia throughout the procedure and can return home within 48 hours. There is no surgical wound – just a small adhesive strip where the catheter was placed. Patients take clopidogrel for a month and aspirin indefinitely; there is no need for a blood thinner. As with all minimally invasive procedures, this mitral valve treatment results in less pain, shorter hospital stays, and quicker recovery time.

Replacement of Heart Valves

Replacement is necessary when the valve is degenerated beyond repair. The old valve is removed and replaced with a new valve mechanism, which can be:

• bioprosthetic, made from animal tissue
• mechanical, typically carbon covered with cloth
• homograft, from donated human tissue