Mitral and tricuspid heart valve repair encompasses surgical and transcatheter interventions aimed at correcting structural defects in the heart's atrioventricular valves. The primary goal is to re-establish unidirectional blood flow between the heart chambers, relieving symptoms of heart failure and preventing progressive ventricular remodelling. According to the 2020 ACC/AHA Guidelines for the Management of Patients With Valvular Heart Disease, valve repair is clinically preferred over valve replacement whenever anatomically feasible due to superior long-term survival and lower risks of thromboembolism and infection.

Surgical heart valve repair is performed under general anesthesia with median sternotomy or minimally invasive right mini-thoracotomy. Cardiopulmonary bypass is established to maintain systemic perfusion while the heart is stopped. The surgeon inspects the valve anatomy and performs targeted reconstruction, such as leaflet resection, chordal replacement with synthetic ePTFE sutures, or leaflet augmentation. An annuloplasty ring is sewn around the valve circumference to restore functional orifice shape and dimensions. In transcatheter edge-to-edge repair (TEER), a catheter is inserted through the femoral vein and guided into the heart under echocardiographic control. A mechanical clip is deployed to grasp the valve leaflets, creating a double-orifice valve that prevents regurgitation.

Preserving the native valve through repair offers distinct clinical advantages over artificial valve replacement. Published registry data from the Society of Thoracic Surgeons (STS) demonstrate that successful mitral repair delivers superior long-term survival, improved preservation of left ventricular ejection fraction, lower risk of systemic stroke, and a lower lifetime incidence of endocarditis compared to valve replacement. Additionally, repair typically eliminates the need for lifelong oral anticoagulation medication.

Early recovery occurs in the hospital over three to seven days depending on whether open surgical or transcatheter techniques are used. Initial mobilization begins within 24 to 48 hours. Sternal healing following open surgery requires approximately six to eight weeks, during which physical lifting is restricted. Transcatheter repair involves a shorter recovery of one to two weeks. Participation in formal cardiac rehabilitation significantly improves functional capacity and long-term cardiovascular health.

Mitral valve repair treats primary (degenerative) mitral regurgitation, secondary (functional) mitral regurgitation, mitral valve prolapse, and leaflet flail. Tricuspid valve repair addresses primary tricuspid regurgitation, secondary tricuspid regurgitation due to pulmonary hypertension or left-sided heart disease, and tricuspid valve endocarditis.

Pre-procedural preparation involves transthoracic and transesophageal echocardiography, coronary angiography, and baseline laboratory testing including complete blood count, renal function, and coagulation panels. Dental clearance is required to rule out hidden sources of bacteremia. Patients must stop specific blood-thinning medications several days prior to surgery according to surgical guidelines. Pre-operative assessment by an interdisciplinary heart team determines surgical risk scores and technical feasibility.

Complications associated with heart valve repair include post-operative bleeding, cardiac arrhythmias such as atrial fibrillation, heart block requiring permanent pacemaker placement, cerebrovascular accident (stroke), renal dysfunction, wound infection, pericardial effusion, and residual or recurrent valve regurgitation. Serious transcatheter risks include device embolization, leaflet detachment, and vascular access site hematoma.

The clinical pathway for heart valve repair begins with a comprehensive diagnostic evaluation using echocardiography and cardiac catheterisation. Pre-procedure planning determines whether open surgical repair, minimally invasive thoracotomy, or transcatheter edge-to-edge repair is indicated. Following the procedure, patients transition from an intensive care environment to a telemetry ward, followed by structured cardiac rehabilitation and serial echocardiographic follow-up at 30 days, 6 months, and annually thereafter.