Minimally Invasive Mitral and Tricuspid Valve Course Curriculum

  • 1

    INTRODUCTION

    • Welcome to the Minimally Invasive Valve Course

  • 2

    Diagnostic Survey

    • This Questionnaire is meant to help us better understand our course attendees

  • 3

    OUR PARTNER SPONSORS

    • Partners in Minimally Invasive Mitral Valve Surgery

  • 4

    IMPORTANT INSTRUMENTS AND EQUIPMENT

    • Surgical Instruments & Supplies

  • 5

    EARLY CONSIDERATIONS

    • INTRODUCTION TO MINIMALLY INVASIVE MITRAL VALVE SURGERY

    • Operating Room Setup

    • Anesthesia Requirements

    • Perfusion Considerations

    • Contraindications to Limited Right Thoracotomy Mitral Valve Surgery

    • Patient positioning

  • 6

    SECTION 1 - Cannulation Technique

    • Cannulation Technique

    • Femoral Cannulation and Decannulation

    • Right Axillary Cannulation

    • Intraoperative Tranesophageal Echocardiogram for Cannulation

    • Transesophageal Echocardiogram for Venous Cannulation

    • Transeosphageal Echocardiogram for Arterial Cannulation

  • 7

    SECTION 2 - Chest Exposure

    • Incision location

    • Chest marking

    • Two teams operating

    • Liposomal Bupivacaine field block and intercostal block.

    • 5mm Scope position and tricuspid view

  • 8

    SECTION 3 - Cardiac Exposure

    • Cardiac Exposure

    • Cardiac Exposure

    • Anterior chest wall atrial lift insertion

    • Anterior chest wall Trocar insertion and its use

    • Cardiac dissection

    • Dissection of the aorta from the right pulmonary artery and opening of the oblique sinus

    • Antegrade Cardioplegia

    • Antegrade cardioplegia and root vent cannula insertion

    • Antegrade cardioplegia and root cannula insertion

    • Antegrade cardioplegia cannula insertion and crossclamp

    • Minimally Invasive Caval Control

  • 9

    SECTION 4 - Mitral Valve Exposure

    • Mitral Exposure

    • Mitral Valve exposure

    • Papillary Muscle Exposure

    • Managing the prosthesis outside of chest

  • 10

    SECTION 5 - Mitral Valve Replacement

    • Mitral Valve Replacement

    • The rheumatic mitral valve replacement

    • Mechanical MVR in severe rheumatic mitral disease

    • The calcified mitral valve and Mitral Annular Calcification (MAC)

    • MVR in severe annular calcification

    • External suture control and prosthesis anchoring.

  • 11

    SECTION 6 - Management of Atrial Septal Defects

    • Atrial Septal Defects

    • Patent Foramen Ovale Closure

    • Large ASD with mitral valve repair performed through it followed by patch closure of the defect.

  • 12

    SECTION 7 - Management of the left atrial appendage

    • Left Atrial Appendage Management

    • MVR bio rheumatic with Left atrial appendage ligation

    • Left atrial appendage closure.

  • 13

    SECTION 8 - Mitral Valve Repair - Posterior Leaflet

    • Posterior valve pathology - P2 flail/prolapse Non-Resectional Techniques

    • P2 Repair with Adjustable multiple chord repair using Figure of 8 Locking Stitch

    • P2 flail repaired with individual ePTFE neochords.

    • P3 + P2 repair (Decalcification of P3 and Leipzig Loop P2)

    • P2 Flail repair using triangular resection

    • P2 Flail repair using Triangular resections

    • Posterior valve pathology - P1 flail/prolapse

    • P1 Repair with Adjustable Multi chord system using Figure of 8 Locking Stitch

    • Posterior valve pathology - P3 flail/prolapse

    • P3 Repair with Medial Commissuroplasty

  • 14

    SECTION 9 - Mitral Valve Repair - Anterior Leaflet

    • Anterior valve pathology - A2 flail/prolapse

    • A2 Repair using Adjustable ChordX system and Figure of 8 Locking Stitch

    • A2 Repair using Leipzig Loop technique

    • Anterior valve pathology - A3 flail/prolapse

    • A3 Repair Using the Adjustable Neochords and Figure of 8 Locking Stitch

    • Anterior valve pathology - A1 flail/prolapse

    • A1 Repair as part of multi-segment Pathology

  • 15

    SECTION 10 - Mitral Valve Repair - Bileaflet Disease

    • Bileaflet Pathology - Barlow's Disease

    • Barlow's Valve Repair with Large Complete Ring

    • Bileaflet Prolapse (functional, non Barlow's)

    • Bileaflet Prolapse (functional, non Barlow's) Repair with Large Complete Ring

  • 16

    SECTION 11 - Sizing the Mitral Annulus

    • Sizing the Mitral Annulus

    • Annular Sizing

    • Placing the annuloplasty sutures during a repair

  • 17

    SECTION 12 - Tricuspid Valve Surgery

    • Tricuspid Valve Repair

    • Tricuspid valve repair.

    • Tricuspid Valve Replacement

    • Tricuspid valve replacement

    • Right ventricular permanent epicardial lead placement minimally invasive

  • 18

    SECTION 13 - Management of Atrial Fibrillation

    • Box Lesion performed minimally invasive with MVR

    • PVI performed minimally invasive with MVR

    • Mini PVI mitral repair

  • 19

    SECTION 14 - Benign Cardiac Tumor Resection

    • Benign Tumor Resection

  • 20

    SECTION 15 - Considerations Before Closing

    • Tasks before closure

    • Left atrial closure and deairing.

    • Before Closing

    • Femoral decannulation

  • 21

    Minimally Invasive Mitral and Tricuspid Valve Webinar

    • Course Summary and Case Discussions

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