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Ten Elements for a Successful Mitral Program

LEARNING OBJECTIVES Identify and understand the essential elements of establishing and nurturing a successful mitral valve program. Understand the importance of the skilled mitral surgeon to the success of an effective mitral valve program. Understand and evaluate advanced imaging techniques that are critical to a high-quality, expert mitral programs: transthoracic and transesophageal echocardiography, computerized tomography (CT), and cardiac magnetic resonance imaging (CMR). . This chapter endeavors…

Establishing a Comprehensive Mitral Valve Program: Educating Patients and Referring Physicians

LEARNING OBJECTIVES 1. Establish the key components necessary to market your program as a comprehensive mitral valve program 2. Learn to build a focused outreach plan to optimize internal and external outreach efforts 3. Learn to improve access to care through collaboration with the referral community INTRODUCTION In the past decade, structural heart programs have proven to be one of the largest areas of growth in…

Quality Improvement and Outcomes

LEARNING OBJECTIVES Understand the principles of quality in care delivery and how they relate to mitral valve interventions. Recognize the need for a successful heart team, and each actor’s specific contribution of a growing mitral valve program. Ensure that best practices are employed to improve patient outcomes, both by objective and self-reported measures. ASSESSING QUALITY IN MITRAL VALVE INTERVENTION Ensuring success in the delivery of mitral…

Developing Successful Structural Heart Programs

LEARNING OBJECTIVES After reading this chapter, one should be able to: Identify the multidisciplinary team members. Define the steps for integrating mitral therapy into an established structural heart program. Describe efficient and effective patient care pathways for patients with mitral valve disease. INTRODUCTION Establishing the appropriate infrastructure is fundamental to optimizing outcomes in the delivery of care for patients undergoing treatment for mitral valve disease. Successful…

Percutaneous Mitral Valve Interventions: Evaluation, Pitfalls, and Complications

LEARNING OBJECTIVES 1. Review the indications for transcatheter mitral valve therapies according to American Heart Association/American College of Cardiology and European Society of Cardiology guidelines. 2. Review scoring systems for the assessment of favorable anatomy for mitral valve balloon valvuloplasty. 3. Review favorable and unsuitable anatomy for transcatheter mitral valve edge-to-edge repair for primary and secondary mitral regurgitation. 4. Discuss the importance of multidisciplinary heart team…

Transcatheter Mitral Valve Replacement

Learning Objectives While a transcatheter approach has become ubiquitous for aortic valve replacement, transcatheter mitral valve replacement has been slower to gain traction. The more complex anatomy and pathophysiology of mitral valve disease, in comparison to the aortic valve, complicates device design and deployment technique of transcatheter replacement for the mitral valve. TMVR is most likely to gain use in the near future as an alternative…

Transcatheter Valvuloplasty

LEARNING OBJECTIVES 1. Patient selection based on anatomical features for percutaneous mitral commissurotomy. 2. Procedural steps of percutaneous mitral commissurotomy. 3. To identify complications of percutaneous mitral commissurotomy and management. 4. Long-term results of percutaneous mitral commissurotomy Kollaborate link: INTRODUCTION Mitral stenosis (MS) continues to be the most common valvular heart disease in the developing and underdeveloped nations. Globally the most common cause of MS…

Transcatheter Mitral Valve Repair

LEARNING OBJECTIVES 1. The mitral valve is a complex anatomical structure that can be difficult to treat from a percutaneous standpoint. In-depth anatomic knowledge is essential to procedural success. 2. Currently approved therapies for percutaneous mitral valve repair are based on surgical approaches. We explore the surgical approaches and provide an in-depth description of the procedures and the data behind their approval in both the United…

Evaluation, Common Pitfalls, and Complications

Learning Objectives 1. Understand the separate preoperative and intraoperative phases of surgical evaluation of mitral valve (MV) disease. 2. Understand evaluation of MV disease in the preoperative phase of care to include indications for surgery, patient suitability for surgery, and determination of surgical approach. 3. Understand intraoperative evaluation of MV disease to include anatomic features of the MV as well as anatomical and hemodynamic assessment of…

Surgical Replacement of the Mitral Valve

LEARNING OBJECTIVES 1. Summarize the indications of mitral valve replacement. 2. Individualize prosthetic valve selection for mitral valve replacement. 3. Describe the most common complications associated with mitral valve replacement. 4. Explain and differentiate three techniques for chordal preservation during mitral valve replacement. INTRODUCTION When the decision is made to operate on a patient’s mitral valve, mitral valve repair (MVr) is typically preferred over replacement whenever…

Mitral Operation: Robotic Approach

LEARNING OBJECTIVES Gain an understanding of the history of robotics. Identify and understand contraindications for mitral valve repair and/or replacement. Learn how to assess patients to determine suitability for robotic surgery. Gain an understanding of techniques, complications, and patient outcomes. HISTORICAL PERSPECTIVE The history of robotic mitral valve surgery is relatively short, with the first robotic mitral valve operation performed in 1998 by Dr. Carpentier. This…

Mitral Operation: Endoscopic Approach

LEARNING OBJECTIVES Understand the indications and contraindications for endoscopic approach to mitral valve surgery. Understand the standard setup and cannulation strategy for mitral valve surgery through an endoscopic approach. Understand tips and tricks for optimizing exposure and dealing with challenges in endoscopic mitral valve surgery. INTRODUCTION Mitral repair or replacement via median sternotomy is the gold standard for surgical interventions upon the mitral valve and remains…

Mitral Valve Surgery: Right Thoracotomy Approach

LEARNING OBJECTIVES 1. To describe basic patient positioning, special equipment, and cannulation strategies for right-thoracotomy/port-access mitral valve surgery 2. To describe the advantages of right-thoracotomy port-access mitral intervention over traditional sternotomy approach 3. To describe the utility of the right-thoracotomy port-access approach in patients with prior sternotomy 4. To discuss strategies to maximize cardioprotection during right-thoracotomy port-access mitral valve intervention INTRODUCTION One of the more time-tested…

Mitral Operation: Sternotomy Approach

LEARNING OBJECTIVES Understand the indications for sternotomy approach to mitral valve surgery. Understand the standard setup and cannulation strategy for mitral valve surgery through sternotomy. Understand tips and tricks for optimizing exposure through sternotomy. INTRODUCTION Mitral repair or replacement via median sternotomy is the gold standard for surgical interventions upon the mitral valve and remains the most common approach. Median sternotomy is universally available, safe,…

Myocardial Protection and Perfusion Techniques in Mitral Valve Surgery

LEARNING OBJECTIVES 1. The mitral valve surgeon should become familiarized with all types of myocardial protection, including routes of administration and cardioplegic solutions. 2. The mitral valve surgeon should know how to select patients for beating heart procedures (being fully aware of its advantages and disadvantages). 3. When choosing the route of cannulation for cardiopulmonary bypass, the surgeon should consider both central and peripheral cannulation as…

Medical Devices and Instruments

LEARNING OBJECTIVES Basic knowledge of sternotomy instruments Basic knowledge of thoracotomy and mini-thoracotomy instruments Review of available catheters and cannulas Tips and pitfalls of the devices and instruments You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy Unlimited articles Become membership If you are a member. Log in here

Cardiac Rhythm Management Implantable Devices

LEARNING OBJECTIVES Understand when permanent pacemaker implantation is indicated and when permanent pacemaker implantation is NOT indicated after mitral valve surgery. Be able to evaluate the choice of a pacing device, including implantable cardioverter defibrillator (ICD) and the various lead placement options. Understand the proper techniques for effective and durable left atrial appendage exclusion. This includes the understanding that left atrial appandage (LAA) exclusion can be…

Diuretics and Neurohormonal Medications

LEARNING OBJECTIVES 1. Understand the benefits of medical treatment in mitral stenosis and regurgitation. 2. Know which medications are indicated and their function in management of mitral stenosis and regurgitation. 3. Gain insight into the preoperative management in patients with severe mitral stenosis and regurgitation. INTRODUCTION In this chapter we review the medical management for mitral stenosis and mitral regurgitation. We go over the pathophysiology of…

Cardiac Catheterization

LEARNING OBJECTIVES 1. Understand the role of cardiac catheterization and its limitation in estimation of stenotic valve area and assessment of severity of mitral regurgitation. 2. Know the critical technical procedural aspects of performing cardiac catheterization as it pertains to assessment of mitral valve disease. 3. The components of Gorlin formula, and their effects on transmitral gradient and application of the formula to assess mitral valve…