At a glance
Mitral valve repair is open-heart surgery that fixes a damaged mitral valve so the heart can pump blood forward without it leaking back the wrong way. The mitral valve sits between the left atrium (the upper-left chamber) and the left ventricle (the lower-left chamber). When it works correctly, it opens to let blood flow into the ventricle and snaps shut to stop blood from flowing backward.
A faulty mitral valve either leaks, a problem called mitral regurgitation (blood flowing backward), or becomes too narrow to open fully, called mitral stenosis (a tight, restricted valve). During repair, the surgeon reshapes, trims, or reinforces the valve's own tissue rather than replacing it with an artificial valve. This preserves the heart's natural structure and usually allows better long-term function.
Medical Condition
Mitral valve repair is used when the valve is damaged enough to affect how well the heart works, but the tissue is still good enough to be reshaped rather than replaced. A cardiologist (heart specialist) and a cardiothoracic surgeon assess each case together before recommending surgery.
- Severe mitral regurgitation caused by a prolapse (when one or both leaflets, the flaps of the valve, bulge back into the upper chamber during each heartbeat)
- Torn or stretched chordae tendineae (the thin cords that tether the valve leaflets to the heart muscle)
- Mitral stenosis in selected patients where the valve tissue is still pliable enough to be widened
- Endocarditis (a heart infection) that has damaged the valve but left enough healthy tissue to work with
- Mitral valve disease discovered during other planned heart surgery, such as bypass surgery
Repair is not always the right choice. Doctors typically recommend valve replacement instead when the valve tissue is severely calcified (hardened with calcium deposits), when infection has destroyed too much tissue, or when previous repair attempts have failed.
- Heavily calcified valve leaflets that cannot be made flexible again
- Extensive tissue destruction from severe or recurrent endocarditis
- Congenital (present-from-birth) valve abnormalities that leave too little usable tissue
- Failed prior mitral valve repair
Risks & Complications
Like all open-heart surgery, mitral valve repair carries real risks. Most patients recover without serious complications, but every person's situation is different and a surgeon will discuss your individual risk profile before you consent to the procedure.
- Atrial fibrillation (an irregular heartbeat) in the days after surgery, which usually responds to medication
- Bleeding during or after surgery, sometimes requiring a return to the operating room
- Stroke caused by a small blood clot traveling to the brain during the procedure
- Wound infection at the chest incision or around the breastbone
- Kidney injury from reduced blood flow during the time on the heart-lung bypass machine
- Incomplete repair requiring a second operation or conversion to valve replacement during the same surgery
- Prolonged need for a breathing machine (ventilator) if the lungs are slow to recover
- Rare but serious risks including heart attack, severe arrhythmia (dangerous heart rhythm disturbance), or death
Preparation & Procedure
Preparation for mitral valve repair begins weeks before the surgery date and involves both lifestyle steps and medical tests. Your surgical team will give you a personalised checklist, but the points below reflect what most hospitals require.
On the practical side, patients are usually asked to stop eating and drinking anything, including water, for at least six hours before surgery. Blood thinners, certain diabetes medications, and some supplements are typically paused in the days before the procedure, on the specific instructions of the surgical team. Smoking makes lung recovery harder, so patients are strongly encouraged to stop as far in advance as possible. Alcohol is also usually avoided for at least a week beforehand.
Several tests help the team plan the surgery and check that the heart and other organs are ready. Common pre-operative tests include an echocardiogram (an ultrasound of the heart to map the valve in detail), an ECG or EKG (a recording of the heart's electrical activity), chest X-ray, blood tests including a full blood count and kidney function, and sometimes a coronary angiogram (an X-ray of the heart's arteries) to check whether bypass grafts are also needed.
On the day of surgery, the team follows an ordered sequence of steps. The exact steps and timing vary between hospitals, but a typical sequence looks like this:
- Admission and identity checks, review of consent forms and final test results
- An intravenous (IV) line is inserted and pre-operative medication is given to help relaxation
- The patient is moved to the operating theatre and connected to monitors for heart rate, blood pressure, and oxygen
- General anaesthesia (medicine that puts the patient into a deep sleep) is given, and a breathing tube is placed
- The surgeon opens the chest by dividing the sternum (breastbone) down the middle, a cut called a median sternotomy
- The patient is connected to a cardiopulmonary bypass machine (heart-lung machine) that takes over the job of pumping and oxygenating blood while the heart is temporarily stopped
- The surgeon works directly on the mitral valve, reshaping leaflets, replacing torn chordae tendineae with artificial cords, and usually implanting an annuloplasty ring (a support ring sewn around the base of the valve to hold the repair in shape)
- The heart is restarted, bypass is stopped, and the repair is tested with an intraoperative echocardiogram (live ultrasound during surgery)
- If the repair is satisfactory, the breastbone is closed with wires and the skin is sutured (stitched)
- The patient is transferred to the intensive care unit (ICU) for close monitoring while anaesthesia wears off
Aftercare
Recovery from mitral valve repair happens in stages, from the ICU to a general ward and then home. Most patients spend one to several days in the ICU, then move to a cardiac ward for several more days before discharge. The full recovery at home typically takes six to twelve weeks, though this varies depending on the patient's age, overall health, and how the surgery went.
- ICU monitoring: heart rhythm, blood pressure, breathing, and drainage tubes are watched closely until the patient is stable enough to move to a regular room
- Breathing exercises: a physiotherapist (movement and breathing specialist) usually guides patients through lung exercises from the first day after surgery to prevent pneumonia (lung infection)
- Chest wound care: the sternotomy incision is kept clean and dry; patients are typically told to avoid lifting anything heavy until the breastbone has healed, which usually takes about six to eight weeks
- Blood thinners: most patients take blood-thinning medication for a period after surgery to reduce the risk of clots; the duration depends on whether an annuloplasty ring was used and on the heart rhythm
- Activity limits: driving is usually restricted for several weeks; returning to desk work may be possible within a few weeks, while physical jobs or heavy exercise take longer
- Cardiac rehabilitation: a supervised exercise and education programme offered by many hospitals helps the heart rebuild strength safely
- Follow-up appointments: an echocardiogram is usually repeated at the first outpatient visit, then at regular intervals, to confirm the repair is holding
- Signs to watch for: fever, increasing redness or discharge at the wound, chest pain, breathlessness at rest, or a very fast or very slow heartbeat should prompt an urgent call to a doctor
Cost & What Determines It
The cost of mitral valve repair varies widely from one patient to the next and from one country to the next. This is one of the more complex cardiac operations, and many separate factors pile up to form the final bill.
- Disease complexity: a straightforward prolapse repair typically costs less than a repair combined with other procedures such as coronary bypass or treatment for atrial fibrillation
- Hospital class: a private international hospital with a dedicated cardiac surgery programme charges differently from a university teaching hospital or a public facility
- Country of treatment: surgical fees, operating theatre charges, anaesthesia, and ICU rates differ significantly between countries, which is often the reason patients travel for this operation
- Length of ICU and ward stay: complications or a slower recovery extend the stay and add to the total
- Implants and devices: the annuloplasty ring used to hold the repair has a procurement cost that varies by type and manufacturer
- Heart-lung bypass consumables: the circuits, oxygenator, and related disposables used during bypass are billed separately in many hospitals
- Pre-operative tests: the echocardiogram, coronary angiogram, and blood work done before surgery are sometimes bundled, sometimes invoiced individually
- Post-operative medications: blood thinners and other cardiac drugs needed after surgery add to the overall cost, especially during a longer hospital stay
- Cardiac rehabilitation: where it is offered as a separate programme rather than included in the surgical package, it carries its own fee
Many hospitals offer a surgical package that bundles the surgeon's fee, anaesthesia, operating theatre use, a set number of ICU days, and standard ward accommodation. Items that are commonly billed outside the package include additional ICU days beyond the package limit, blood products, the specific annuloplasty ring or other implants, coronary angiogram if required, and physiotherapy sessions.
Indonesian patients travelling abroad for mitral valve repair almost always pay out of pocket, because BPJS Kesehatan and most Indonesian private insurance policies do not cover treatment received outside Indonesia. Some international private insurance plans do provide overseas cardiac coverage, so checking the policy carefully before booking is worthwhile. Asking the hospital for a detailed written cost estimate, broken down by item, before travelling is the most reliable way to understand the full financial commitment and avoid unexpected charges on discharge.
Frequently Asked Questions
How long does mitral valve repair surgery take?
Mitral valve repair usually takes between three and five hours, though the exact time depends on how complex the valve damage is and whether any additional heart work is needed at the same time. You will also spend time before the operation being prepared for anaesthesia, and time in a recovery area afterwards before moving to the ward.
Will I be awake during the operation, and how bad is the pain afterwards?
You will be fully asleep under general anaesthesia (medicine that puts you into a deep sleep so you feel nothing) for the entire operation. After surgery, most people have chest soreness around the incision site and some discomfort from the breathing tube that was used, but the medical team manages this with pain relief so the first days are usually tolerable.
How long is recovery, and when can I go back to work?
Most people stay in hospital for about a week, including a short period in the ICU (intensive care unit) right after surgery, and then spend four to eight weeks recovering at home before returning to light work. Physical jobs or any heavy lifting usually require a longer break, and your cardiologist will advise when it is safe based on how your heart is healing.
How much does mitral valve repair cost?
The cost varies based on several factors specific to this operation, including the surgical technique used (traditional open-chest or minimally invasive), the length of your ICU and ward stay, any repair devices or rings placed in the heart, and the class of hospital room you choose. Requesting a written cost estimate directly from the hospital is the most reliable way to get a figure that reflects your individual case.
This page is general information, not a substitute for medical advice. Every case is different. Your doctor decides what is right for you.
