2 Indications and current treatments
2.1 Mitral valve replacement is done for severe mitral valve stenosis, mitral regurgitation or a combination of both. Symptoms of severe mitral valve disease typically include shortness of breath, fatigue and palpitations (arising from atrial fibrillation).
2.2 If symptoms of mitral valve disease are sufficiently severe, valve replacement with an artificial prosthesis (bioprosthetic or mechanical) may be done by open heart surgery in patients who are well enough for this kind of operation. Bioprosthetic valves have some advantages over mechanical valves, but they are more likely to degenerate and fail over time. This can result in severe stenosis or regurgitation, needing replacement of the bioprosthetic valve.
2.3 The standard treatment for a failed bioprosthetic valve is repeat open heart surgery to replace the valve. Repeat open heart surgery is associated with a higher risk of morbidity and mortality than primary surgery. Transapical transcatheter mitral valve‑in‑valve implantation is a less invasive alternative when repeat open heart surgery is considered to have a high risk. It avoids the need for cardiopulmonary bypass and can be used to treat failed bioprosthetic mitral valves originally placed during open heart surgery.