If you tire easily and have shortness of breath that seems to be getting worse, you could have mitral valve disease and be in need of mitral valve repair. 

The mitral valve controls blood flow from the upper to the lower chamber in the left side of your heart, and roughly 1.3 million U.S. adults suffer from leaky mitral valves—a number that is expected to increase to 2.3 million by 2030. Repairing them is critical for long-term cardiac health.

But how do you know what to look for in a surgery center or hospital for mitral valve repair? Dominic Emerson, MD, director of Robotic Cardiac Surgery at Cedars-Sinai, weighs in with some expert advice.

Dominic Emerson, MD: For most mitral valve problems—what we call “degenerative mitral regurgitation,” also called mitral valve prolapse or a murmur—multiple studies have demonstrated repair is better than replacement for long-term cardiac function. A center’s repair rate should be greater than 90%. Here at Cedars-Sinai, ours is approaching 99%.

Our track record has earned us distinction as a Mitral Valve Repair Reference Center from the American Heart Association and the Mitral Foundation. Very few centers have received this award, which recognizes a record of superior clinical outcomes resulting from evidence-based, guideline-directed degenerative mitral valve repair.

For some patients (for instance, those with an infected valve), repair might not be an option, and in those cases we replace the valve. In almost 100% of cases, we know before going into surgery whether repair will be possible.

DE: The default for mitral valve repair surgery at many centers is a sternotomy, or a traditional open chest approach. Open valve repair can be highly effective, but robotic valve repair—which is less invasive—leaves smaller incisions, causes less pain and reduces recovery time.

The minimally invasive space is small: Nationally, only about 15% of mitral valve repairs are done robotically. But at Cedars-Sinai, we use the technique on almost every patient with this disease process. In fact, we perform more of these than anyone in the western U.S. Last year, we did over 200.

Read: Cedars-Sinai Leads the Way with First-in-Human Experience of Promising Transcatheter Mitral Valve Therapy

DE: One of the most important elements in a successful mitral valve repair is having a multidisciplinary team managing the case. All good centers are built on close collaboration—surgeons and cardiologists should not be making decisions in a vacuum. When you’re choosing a place to go for your procedure, make sure they subscribe to this team approach.

DE: Defining what makes something the best center for your particular situation isn’t always simple. Depending upon your insurance and resources, it’s not always easy to travel to a Mitral Valve Repair Reference Center, which may be far away from where you live. And, of course, having your support system (family, friends) nearby is important, which may sway you toward staying closer to home.

What I tell patients is this: The goal is only to do this surgery once, so focus on trying to find the best and most experienced team available to you. Once you’ve selected a center with good outcomes, try to relax. You’ll be back on your feet before you know it!