Mastering the Mitral Valve

Podcast Transcript

Announcer:

Welcome to Cleveland Clinic Cardiac Consult, brought to you by the Sydell and Arnold Miller Family, Heart, Vascular and Thoracic Institute at Cleveland Clinic.

Brian Griffin, MD:

I'm Brian Griffin. I'm Section Head of Cardiovascular Imaging at Cleveland Clinic. I'm Co-Director of the Mitral Valve Center with my friend Mark Gillinov, who's here beside me. It's a pleasure to talk to you today.

Marc Gillinov, MD:

I'm Mark Gillinov, Chair of Cardiac Surgery at Cleveland Clinic and Co-Director of the Mitral Center with Dr. Griffin, who is the brains behind the operation.

Brian Griffin, MD:

We've got the course in New York in two weeks, "Mastering the Mitral Valve" which I think will be just a fantastic course for all of the clinical scenarios that are bothersome about the mitral valve will be dealt with. We're going to have a fantastic group of people both from Cleveland Clinic and from outside who are going to tell us what we should do in these situations. I think this has got to be a phenomenal event. What do you think?

Marc Gillinov, MD:

I think you hit on the key point, which is that we're going to discuss cases from the simplest everyday case, to the most complex, to the simple case that doesn't go quite right. Then answer the question, how do you manage these cases? What do you do for something that's simple to guarantee an outstanding result? How do you manage the super complicated case that you're not even sure you should address, whether it's in the cath lab or in the operating room. I think it's very important to discuss, what do you do when things don't go the way you planned? How do you get your team together to take care of issues that are going to arise from time to time? That's what I gain from courses like this, discussion amongst experts as to what should I do when I'm faced with this complex situation in the clinic or in the OR.

Brian Griffin, MD:

I think that's absolutely right. I think the complex scenarios are really increasing with the mitral valve because people are living longer. Their expectations are much greater. People want good quality of life and mitral valve disease is very common. Also, our ability to treat these and to understand what's going on has changed. I think from my perspective, obviously the imaging of this has changed a lot. We now have three-dimensional approaches to really understanding the valve as it happens if you like, before we get into the operating room or into the cath lab. That's been a huge game changer.

Brian Griffin, MD:

I think we've learned a couple of other things. Mitral annular disjunction is kind of a really interesting thing in terms of its proarrhythmia that we're going to discuss. We're going to have electrophysiologists there to talk about that, the interface between mitral valve disease and heart failure, particularly with regard to ischemic and secondary and more. I think we're really going to get into that. I think it'll be great. I think you're absolutely right. Mitral valve seems simple, but boy it can be pretty tough at times.

Marc Gillinov, MD:

Even the simple P2 prolapse, what should you do? It used to be you wait until they have symptoms and then you operate. Now you don't wait until there are symptoms, but should you get transcatheter edge to edge repair? Should you get a robotic approach? Should you get a sternotomy? We have so many options that it requires a real heart team discussion. Bringing in the patient to decide what's going to be the best option for each individual. Simple is not so simple anymore.

Brian Griffin, MD:

Absolutely. I think what's exciting too is that now there will be clinical trials looking at the options, comparing people who have relatively straightforward mitral valve prolapse, whether they should have a clip, whether they should have surgery, what's the best approach? We don't know. That's where clinical trials are really important. Of course, you've been very involved in designing these in the mitral valve space, so I think that'll be exciting too, to hear all about that.

Marc Gillinov, MD:

Yeah. We'll have up to date information on both the NIH trial and the industry sponsored trial for the clip or edge to edge repair compared to surgery and see where those are going.

Brian Griffin, MD:

I think one of the other things is we've all kind of been hanging out in COVID land and now this is an opportunity to catch up. We're also going to have a section on what did we miss while COVID was occurring with regard to mitral valve disease in terms of quite a number of new things have occurred. A lot of us maybe didn't hear all of those things, so we're going to discuss that too. I think that would be really exciting. I think the other thing is it's a fabulous time to be in New York, so we might not get there that much ourselves because we'll be pretty busy, but I think for people who come or with spouses or family or whatever, it's just a perfect time to be in New York.

Marc Gillinov, MD:

New York. The holidays. The mitral valve. Three good things.

Brian Griffin, MD:

Great. Thank you.

Announcer:

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