Ten Elements for a Successful Mitral Program

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This chapter endeavors to identify the essential elements of establishing/maintaining a successful mitral valve program based on at least two decades of personal experience and observation in this environment. Many readers will recognize that these will be largely the same elements inherent in a successful structural heart program and, to be fair, there is little light between the two.

As in most recipes, the best cooks will have a deep understanding of the fundamental ingredients but decide that certain modifications lead to a better meal—the same is true with this list, which is meant to be a starting point but is by no means exhaustive or exclusive.

CARDIAC SURGERY EXPERTISE

Many referrals for mitral valve disease to any institution by other cardiac specialists will be to surgeons for definitive therapy. This flow of patients will be the bedrock on which other diagnostic and therapeutic modalities—and resultant program expansion—will be built. Therefore, an experienced mitral surgeon skilled in all forms of repair, in minimally invasive access, and in the office and peri-operative management of mitral disease will be critical to a successful program. Mitral valve surgeons have a unique understanding of valve anatomy that can add valuable insight to whatever procedure is planned for.

Although there have been and will be fantastic innovations in the percutaneous treatment of mitral valve disease, at its core—historically and practically—it is a surgical domain. In the current environment, there are still many patients who will not qualify for percutaneous therapies by virtue of anatomical or access restrictions, durability of results, etc., and will require expert surgical care.

Last, although non-surgical specialists and cardiac surgeons may be well-versed in mitral disease (from multiple viewpoints), there is still much to learn from each other that will not only enrich our individual perspectives but also promote better patient outcomes.