Use Lesions to Guide Mitral Repair Strategy

David H. Adams, MDCardiac Surgeon-in-ChiefMount Sinai Health System Marie Josée and Henry R. Kravis Professor and ChairmanDepartment of Cardiovascular SurgeryIcahn School of Medicine at Mount SinaiNew York, NY

Icahn School of Medicine at Mount Sinai has royalty agreements with Edwards Lifesciences and Medtronic:

Physio II Mitral Annuloplasty Ring IMR ETlogix Mitral Annuloplasty Ring TriAd Tricuspid Annuloplasty Ring

National Co-PI: Medtronic CoreValve US Pivotal TrialNational Co-PI: NeoChord System US Pivotal TrialNational Co-PI: Medtronic Apollo US Pivotal Trial

Disclosures: David H. Adams, MD

Adams DH, Rosenhek R, Falk V. Eur Heart J 2010;31:1958

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Leaflet Height and Volume

Height Volume Support

Leaflet Resection: What You Can Control

Basic Resection Techniques

Triangular resection

Quadrangular resection

Leaflet detachment

Leaflet base tailoring

Leaflet Resection Strategy

Target areas of chordal pathology

Correct excess height

Normalize leaflet volume

Target abnormal indentations or clefts

Blending Approaches Is The Best Strategy

Triangular Resection Strategies

Limited Triangle

Larger Triangle

Asymmetric Triangle

Anterior Leaflet Triangular Resection

Bileaflet Triangular Resection

Quadrangular Resection Strategies

Unilateral Detachment Bilateral Detachment

Quadrangular – Unilateral Detachment

Quadrangular Resection – Bilateral Detachment

Quadrangular Resection – Bilateral Detachment

Take Home Points

Adapt resections to leaflet pathology

Only resect what is necessary

Focus on the leaflet height, volume, and free margin support

Thank You