Mitral Valve Replacement: Surgery, Valve Types and Recovery
Updated: 2 days ago
Written and medically reviewed by Dr. Baraa Alnahhal, MD · Last reviewed: November 2026 · How we review
Quick Answer
Mitral valve replacement is open-heart surgery that removes a damaged mitral valve and puts in a new one when the valve can't be repaired. It treats mitral valve regurgitation and stenosis. The new valve is mechanical (lasts 20 to 30 years, needs lifelong blood thinners) or biological (lasts 10 to 20 years). Recovery takes four to eight weeks.
What the research says
Replacement fixed leaking more durably than repair: in a trial of 251 people with severe ischemic mitral regurgitation, 1-year survival and heart remodeling were similar after repair or chordal-sparing replacement, but the leak came back moderately or severely in 32.6% after repair versus 2.3% after replacement (Acker MA et al., New England Journal of Medicine, 2014) [2]
Mechanical valves were linked to longer survival before age 70: in a large California study of valve replacement from 1996 to 2013, people aged 40 to 69 who got a mechanical mitral valve had lower long-term mortality than those with a biological valve, though mechanical valves came with more bleeding and biological valves with more repeat surgery (Goldstone AB et al., New England Journal of Medicine, 2017) [3]
Key takeaways
Mitral valve replacement swaps a damaged valve for a new one.
Surgeons replace the valve only when repair isn't likely to work.
Mechanical valves last longer but need lifelong blood thinners.
Biological valves need blood thinners for only a few months but wear out sooner.
Most people spend about a week in the hospital and recover in four to eight weeks.
What is mitral valve replacement?
Your mitral valve sits between the two left chambers of your heart. Oxygen-rich blood flows from your lungs into the left atrium, through the mitral valve and into the left ventricle, which pumps it out to your body. In mitral valve disease, the valve can't open or close properly, which strains the left side of your heart and over time can damage your heart and lungs. Mitral valve replacement is a type of heart valve surgery that removes the damaged valve and sews in a new one. Sources: [1]
Why it's done
Surgeons try to repair the valve first whenever possible.
Mitral valve replacement treats mitral valve regurgitation (a leaky valve) and mitral valve stenosis (a narrowed valve). Surgeons try to repair the valve whenever they can. They recommend replacement when repair has a low chance of success, for example because of: Sources: [1]
Severe damage from endocarditis or rheumatic heart disease.
Extensive calcium deposits or scarring.
A lot of damage to the papillary muscles or chordae, which support the valve. Sources: [1]
It's a good idea to be evaluated at a high-volume hospital, where surgeons do many valve operations and are experienced in deciding whether repair or replacement is better for you. Sources: [1]
Mechanical vs. biological valves
Your age and health help decide which valve fits you.
Feature | Mechanical valve | Biological valve |
Made of | Carbon and steel | Pig, cow or (rarely) human tissue |
How long it lasts | 20 to 30 years | 10 to 20 years |
Blood thinners | For life | Up to three months after surgery |
Often suits | People under 50 | People over 65 |
If you're between 50 and 65, your provider may suggest either type depending on your situation. Lifelong anticoagulants can be risky for some people, such as those who are pregnant or have a higher risk of falls or injuries. Sources: [1, 3]
How common is it?
Heart valve surgery is the second most common heart surgery in the U.S. About 90,000 people in the U.S. and about 280,000 worldwide have a heart valve replaced each year, and the mitral and aortic valves are the ones most often replaced. Sources: [1]
How to prepare
Stop certain medicines in the weeks before surgery, as your provider directs.
Stop smoking and using tobacco products.
Wash with an antimicrobial soap the night before.
Stop eating and drinking after a set time, usually midnight.
Take the medicines your provider tells you to on the day of surgery. Sources: [1]
You may also get medicine for conditions like heart failure or atrial fibrillation before surgery. Plan for your return home by putting everyday items within easy reach and arranging a ride from the hospital. Sources: [1]
What happens during surgery
Surgery usually takes two to four hours.
You get general anesthesia, so you're asleep.
You're connected to monitors and get antibiotics through an IV.
A heart-lung bypass machine takes over for your heart and lungs.
The surgeon makes a chest incision, usually a sternotomy, and opens the left atrium.
Damaged tissue is removed, keeping as much natural tissue as possible.
The new valve is sewn into place and checked to make sure it moves freely.
The left atrium is closed and you're slowly taken off the bypass machine. Sources: [1]
Your team uses a transesophageal echocardiogram throughout to guide the work and confirm the valve works well. Surgery usually takes two to four hours, longer if you have other procedures at the same time. Sources: [1]
Benefits and risks
Benefits | Possible complications |
Shorter than repair surgery, with less time on the bypass machine | Abnormal heart rhythms |
Less complex than repair (though still very complex) | Bleeding and blood clots |
Lower risk of needing another surgery later | Heart block, heart failure, infection or stroke |
Complications can happen soon after surgery or later. Talk with your provider about your own risks and how to lower them. Sources: [1, 2]
Recovery
Most people stay in the hospital about a week, including one or two days in intensive care.
An abnormal heart rhythm is very common afterward and may be treated with medicine or a temporary pacemaker.
You'll start blood thinners to lower your risk of a clot.
Cardiac rehab helps you get back on your feet faster.
Full recovery usually takes four to eight weeks, sometimes longer. Sources: [1]
Recovery can be slower if your valve disease was severe, your heart function was low, you had heart or kidney failure, or you had other procedures at the same time. Your provider will tell you when it's safe to drive, lift heavy objects or take walks. Heart-healthy eating, regular activity, a healthy weight and avoiding tobacco and alcohol help protect your new valve. Sources: [1]
Outlook
Almost everyone survives mitral valve replacement, though risks rise with age. About half of people live at least 10 more years, with either a biological or a mechanical valve. Long-term survival is better when you only need the valve replaced, it's your first valve surgery, the surgery is planned rather than an emergency, and some healthy valve tissue can be kept. Sources: [1]
Other options
Some people can have transcatheter mitral valve replacement (TMVR), a minimally invasive procedure that avoids open-heart surgery. Robotic heart surgery can replace the valve without cutting through the breastbone. Your provider will tell you if these are options for you. Sources: [1]
When to call your provider
Chest pain or shortness of breath.
Fever, chills, or oozing from your incision.
Coughing up blood or yellow or green mucus.
Dizziness, fainting or a pulse that's too slow or too fast.
A very severe headache, slurred speech or other signs of stroke.
Pain, redness or swelling in your lower leg.
Pain around your incision that won't go away, or nausea and vomiting. Sources: [1]
Call 911 for chest pain, severe shortness of breath or signs of a stroke. If you take blood thinners, call your provider if you fall, bleed heavily or have many bruises. Sources: [1]
Conclusion
Mitral valve replacement can relieve the symptoms of severe mitral valve disease and protect your heart when the valve can't be repaired. Choosing the right valve type and keeping up with follow-up care are key to a good long-term result.
Keep learning: read about mitral valve repair and heart valve replacement.
Frequently asked questions
What is mitral valve replacement?
Open-heart surgery that replaces a damaged mitral valve with a new mechanical or biological valve.
Why replace instead of repair?
Surgeons replace the valve when repair has a low chance of success, such as with severe damage, heavy calcium or damaged support structures.
Which valve type is better?
Mechanical valves last longer but need lifelong blood thinners; biological valves need them for only a few months but wear out sooner.
How long does the surgery take?
Usually two to four hours.
How long will I stay in the hospital?
About a week, including one or two days in intensive care.
How long is recovery?
Usually four to eight weeks, sometimes longer.
Will I need blood thinners?
Yes. With a mechanical valve you take them for life; with a biological valve, for up to three months.
What is the life expectancy after mitral valve replacement?
About half of people live at least 10 more years, with either valve type.
Can the mitral valve be replaced without open-heart surgery?
Some people can have TMVR or robotic surgery instead. Your provider will tell you if these are options.
When should I call my provider?
For chest pain, shortness of breath, fever, an irregular pulse, leg swelling or signs of a stroke.
Related Reading
Mitral Valve Repair: Surgery Steps, Recovery Time, Risks and How Long It Lasts the surgery tried before replacement.
Transcatheter Mitral Valve Replacement (TMVR): Procedure, Risks and Recovery a less invasive option.
What Is Mitral Valve Regurgitation? A Plain-Language Guide to This Common Heart Valve Problem a leaky mitral valve.
Mitral Valve Stenosis: Symptoms, Causes, Diagnosis, and Treatment Explained a narrowed mitral valve.
Heart Valve Replacement: Valve Types, Procedure and Recovery replacing any heart valve.
References
Cleveland Clinic. Mitral Valve Replacement: Surgery & Recovery. Cleveland Clinic. Last updated August 7, 2025. https://my.clevelandclinic.org/health/treatments/23132-mitral-valve-replacement
Acker MA, Parides MK, Perrault LP, et al. Mitral-valve repair versus replacement for severe ischemic mitral regurgitation. New England Journal of Medicine. 2014;370(1):23-32. PMID 24245543. https://doi.org/10.1056/NEJMoa1312808
Goldstone AB, Chiu P, Baiocchi M, et al. Mechanical or biologic prostheses for aortic-valve and mitral-valve replacement. New England Journal of Medicine. 2017;377(19):1847-1857. PMID 29117490. https://doi.org/10.1056/NEJMoa1613792
Medical disclaimer
This article is for general education only and does not replace advice from a qualified healthcare professional. Talk to your doctor about your own diagnosis and treatment, and seek emergency care right away for severe or sudden symptoms.
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