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
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