The Mount Sinai Hospital The Mitral Foundation

  • Posterior Leaflet Prolapse

    Figure 1: Posterior leaflet quadrangular resection, annular plication.Posterior leaflet prolapse due to fibroelastic deficiency is most commonly treated by a resection of the prolapsed segment affected by chordal rupture (Figure 1). The prolapsed segment is removed by excising a quadrangular portion of the leaflet. The posterior annulus is then vertically plicated by placing and tying several sut...

  • Anterior Leaflet Prolapse

    Figure 1: Anterior leaflet triangular resectionUnlike the posterior leaflet, aggressive resection of the anterior leaflet margin is not feasible due to anatomic constraints. Therefore the strategies employed for anterior leaflet prolapse are designed to correct prolapse without resection of significant areas of leaflet tissue. Very limited prolapse of the anterior leaflet can be treated by a small...

  • Remodeling the Annulus

    Figure 1: Annular remodelingAfter addressing the prolapsing segments in the anterior and/or posterior leaflet, attention then turns to restoring normal annular geometry (Figure 1). The normal ratio between the antero-posterior (septo-lateral) and transverse diameter of the mitral annulus is approximately 3:4 during systole. This ratio inverts in patients with chronic mitral regurgitation resulting...

  • Minimally Invasive Heart Surgery

    We have helped pioneer small access incision valve surgery. We will always make the smallest possible incision for safe and efficient surgery. In general, incisions are normally closed with stitches beneath the skin that dissolve in 2-3 months, minimizing visual scar tissue.Mitral valve repair is the gold standard procedure for patients who require surgery for mitral valve disease1. This is partic...

  • Who Should Perform Your Mitral Valve Repair?

    It is not enough to ask your surgeon for his or her overall repair rate; you will need to know their success rate for the specific problem that you currently suffer. For example, a surgeon may be successful in repairing 90% of all valves, but may be successful in repairing only 50% of Barlow valves. You should proceed with a repair only if the surgeon feels he or she can guarantee a repair with a ...

  • Understanding Outcomes of Mitral Valve Repair

    When it comes to heart valve surgery, always seek a specialist. There is a large body of evidence1 showing that the quality of outcomes is directly related to the volume of specific specialized surgical procedures that a given team performs. That's not just true for surgeons, but for other team members including: anesthesiologists, critical care doctors, and other health professionals.As cardiac s...

  • Operative Mortality and Morbidity

    The operative mortality rate for mitral valve surgery has steadily declined over the past decade, with the current mortality rates reported to the Society of Thoracic Surgery Database in the region of 1.5% for mitral valve repair and 5.5% for mitral valve replacement. There is a suggestion that centers doing large numbers of repairs for degenerative mitral valve disease deliver especially low mort...

  • Mitral Valve Repair vs. Replacement Rates

    Dr. David Adams performing mitral valve repair surgery alongside surgical partner Dr. Ahmed El-Eshmawi.Numerous studies that have compared long term-survival of patients undergoing mitral valve repair or replacement have consistently shown a survival benefit with mitral valve repair. The ‘repair rate’ is thus an important variable. The ideal repair technique should be applicable to over 90% of cas...

  • Long Term Survival

    Figure 1: Comparison of observed and expected survival after mitral valve surgery Figure 2: Survival after mitral valve surgery according to preoperative echocardiographic ejection fraction (EF).When interpreting data on long-term survival, it should be appreciated that available data refer to the outcomes of mitral repair and cardiac surgery as practiced 10 to 20 years ...

  • Failures and Re-operations

    Figure 1: Outcome after mitral valve repair.Failure of repair, defined by recurrence of moderate or severe mitral regurgitation, or re-operation for mitral regurgitation are principal endpoints to evaluate the long-term outcomes of mitral valve repair. Failure rates of mitral valve repair are determined principally by the original dysfunction (posterior leaflet, anterior leaflet and bi leaflet) an...