Highlights From the 2025 AATS Mitral Conclave

Technical Insights for Mitral Valve Repair and Replacement

Dr. Bacha, who was named 106th president of the AATS in May, delivered welcome remarks during the first plenary session; he also moderated a deep dive panel on congenital valve disease and spoke on managing the tricuspid valve in systemic right ventricle.

Other key presentations by NewYork-Presbyterian surgeons, who shared surgical techniques and advancements in mitral valve repair and replacement, included:

Dr. Stephanie Mick

Adding a Biatrial Maze and LAA Closure: Dr. Mick gave a presentation on robotic biatrial maze, also known as Cox-maze IV, and left atrial appendage ligation (LAAL), explaining how these procedures can be performed at the time of robotic mitral valve repair to treat atrial fibrillation, restore normal heart rhythm, prevent clots, and reduce the risk of stroke. She highlighted various methods of sealing off the left atrial appendage, and the advantages and considerations of using a robotic approach to perform these procedures.

Dr. Arnar Geirsson

Robotic Repair With Neochordoplasty: Dr. Geirsson presented on robotic mitral valve repair with neochordoplasty, a minimally invasive technique used to repair mitral valve prolapse by implanting artificial chords to support the leaflets. He emphasized the benefit of robotics in providing superior visualization for the procedure and shared his guidelines for where and how to place the neochords, how to determine chord length, and his techniques for implantation.

Dr. Andrew Goldstone

AV Canal Repair: Dr. Goldstone shared various surgical approaches to repairing atrioventricular septal defects, including the two-patch repair, modified single-patch repair, single-patch repair, and a central patch technique. He also discussed technical pearls for addressing the left atrioventricular valve and how it can be repaired; compared outcomes for several of the repair strategies; and discussed the risks for reoperation.

Dr. Isaac George

Polymer Surgical Valve Replacement: Dr. George’s presentation focused on a novel mitral valve replacement made of a degradation-resistant synthetic polymer material that poses a promising alternative to current tissue and mechanical valve options. He shared one-year results from a multicenter trial he led to test valve performance, which included no evidence of valve degeneration and no valve reintervention, with excellent hemodynamics. Dr. George also discussed future clinical research, including a proposed investigational device exemption study in the U.S.

Dr. Mario Gaudino

Applying Guidelines in Daily Clinical Practice: Dr. Gaudino discussed the challenges and nuances of balancing professional guidelines for the surgical treatment of heart disease with individual clinician judgment. He shared research that explores the reasons why many surgeons may not conform with recommended best practices, which could include hospital protocols and practices, lack of awareness, surgeon comfort, local/regional practices, and other factors influenced by clinical context or patient risk and comorbidities. Ultimately, Dr. Gaudino points out that there are no one-size-fits-all solutions, emphasizing that guidelines, while a good starting point, cannot replace individualized patient care.