1. Surgical Mitral Valve Repair: What is the Gold Standard?
Donald D. Glower, M.D.
Duke University Medical Center
lit review
robot video
CRT min

2. Disclosure Statement of Financial Interest
Within the past 12 months, I or my spouse/partner have had a financial interest/arrangement or affiliation with the organization(s) listed below.
Affiliation/Financial Relationship
Company
Grant/Research Support
Consulting Fees/Honoraria
Major Stock Shareholder/Equity
Royalty Income
Ownership/Founder
Intellectual Property Rights
Other Financial Benefit
Company Names

3. Gold Standard Therapy Best available outcome Documentation
Reliable, reproducible results

4. DMR: Carpentier Repair Techniques

5. DMR: 20-Year Reoperation
Braunberger, Carpentier Circ 104,I-8, 2001

6. DMR: 12-Year Recurrent MR
David JTCVS 130:1242, 2005

7. FMR Repair 2017
COMPLETE,
UNDERSIZED / FLATTENED, RIGID RING

8. FMR: Recurrent MR CTSN TRIAL - 2 years Goldstein D NEJM Nov 9, 2015
REPAIR
REPLACE P
>=2+MR
59% 4%
<0.001
Reoperation 3% 1% NS EF
43±12
38±12
LVESVI
53±28
61±39
0.19
Ring size 28, 25% no CABG, 12% subvalvular repair procedures
Goldstein D NEJM Nov 9, 2015

9. FMR: Recurrent MR EVEREST II randomized trial 5 year results
Presented at EuroPCR 2014
S Kar et al.
MitraClip not FDA approved for FMR
COAPT Trial ongoing

10. Surgical Mitral Repair Rates
Posterior prolapse %
Anterior prolapse 90%
Bileaflet prolapse 90%
IMR % (70%)
FMR-nonischemic 90% (60%)
Rheumatic 15%
Acute endocarditis 30%
Prior repair 30%

11. Surgical Mitral Repair Rate
Gammie JF ATS 87;1431,2009

12. Surgical Repair Rate v Volume
Bolling SF ATS 90;1904,2010

13. 100% Mitral Repair?
NORMAL MITRAL
END STAGE MITRAL

14. Surgical DMR Early Outcomes
Mortality 1%
Stroke 1%
Wound infection 0.3%
Atrial fibrillation 20%
Transfusion 0-2U
LOS 5 days

15. Surgical Mitral Repair Unknowns
New Gold Standards? - Need late results
Nonresectional repairs
Minimally invasive, Robotic approaches
Different Gold Standards for Different Patients?
DMR repair vs FMR replacement
Pressures of Nonsurgical Therapies - Percutaneous
More minimally invasive surgery?

16. Surgical Mitral Repair Gold Standard
Median Sternotomy
On pump
Carpentier resectional techniques (DMR)
Low but real morbidity/mortality
20 year results (DMR)
10-15% reoperation
10 year results (DMR)
10-30% >=3+MR
20-60% >=2+MR