Mitral Valve Repair5 Techniques95% Repair

A. Marc Gillinov, M.D.

Disclosures

Speaker/consultant• Edwards Lifesciences• Medtronic• Abbott• CryoLife• ClearFlow• AtriCure

Research support• Abbott

Degenerative Disease

Mitral Repair:The Gold Standard

Mitral Magic

5 Techniques for 95% Repair

• Triangular resection• Sliding repair• Artificial chords• Commissuroplasty (Close commissure)• Annuloplasty

Surgical TechniquesA Simple Approach

Simplified Approach

Posterior leaflet prolapse• Triangular resection• Sliding repair

Anterior leaflet prolapse• Artificial chordae

Commissural prolapse• Close the commissure

Posterior Prolapse Repair Techniques

Triangular Resection

Indications

• Segmental posterior prolapse• Low risk of SAM

Sliding Repair

Indications

• High risk of SAMExcess leaflet tissueSmall, hyperdynamic LVNarrow LVOT

• Extensive resection

Artificial Chordae

Artificial Chordae2 Techniques

• Free-hand chordae• Pre-measured chordal loops

Free-Hand Chordae

Free-Hand ChordaePapillary Muscle

Gore-tex stitch through papillary muscle• CV-4 • Figure of eight• Through tip of pap muscle• Avoid entrapping normal chordae

Free-Hand ChordaeLeaflet Edge

Gore-tex stitch through leaflet edge• Each needle passes twice through leaflet• Ventricular to atrial side of leaflet• Needles finish adjacent to each other• Each chord spans 1 cm at leaflet edge

Commissural Prolapse

Annuloplasty

Repair Techniques

AnnulusLeaflets BOTH

5 Techniques for 95% Repair

• Triangular resection• Sliding repair• Artificial chords• Commissuroplasty (Close commissure)• Annuloplasty

Mitral Valve Repair�5 Techniques�95% RepairDisclosuresSlide Number 3Slide Number 4Slide Number 5Slide Number 65 Techniques for 95% RepairSlide Number 8Simplified ApproachSlide Number 10Slide Number 11IndicationsSlide Number 13Slide Number 14Slide Number 15Slide Number 16Slide Number 17IndicationsSlide Number 19Slide Number 20Slide Number 21Slide Number 22Slide Number 23Slide Number 24Slide Number 25Slide Number 26Slide Number 27Artificial ChordaeArtificial Chordae�2 TechniquesFree-Hand ChordaeFree-Hand Chordae�Papillary Muscle�Free-Hand Chordae�Leaflet Edge�Slide Number 33Slide Number 34Slide Number 35Slide Number 36Slide Number 37Slide Number 38Slide Number 39Slide Number 40Slide Number 41Commissural ProlapseSlide Number 43Slide Number 44Slide Number 45Repair TechniquesSlide Number 475 Techniques for 95% Repair