Mitral Valve Repair vs. Replacement: Hemodynamics in Valve Surgery

Mitral regurgitation (MR) is a common valvular heart disease. In the surgical management of MR, mitral valve repair offers significant advantages over replacement by allowing for the optimal preservation of the native valve structure and function. Studies indicate that, compared to valve replacement, repair procedures are superior in restoring physiological left ventricular flow patterns-specifically by optimizing the distribution of kinetic energy, increasing the proportion of direct flow, maintaining normal vortex structures, and effectively reducing energy loss. Replacement with either mechanical or bioprosthetic valves, while effectively correcting regurgitation, substantially alters the left ventricle fluiddynamic environment, leading to increased energy loss and an elevated thrombotic risk. This review discusses the impact of mitral valve repair versus replacement on intra-left ventricular hemodynamics. It further proposes that re-establishing organized left ventricular flow patterns, rather than merely achieving imaging-based improvements, represents a new cornerstone for achieving favorable long-term patient outcomes.