A Measurement-Guided Approach for Degenerative Mitral Valve Repair With Folding Plasty Technique

Historically, mitral valve repair has been seen as an art mastered by few and guided by experience. This video demonstrates an innovative, measurement-based approach developed by Dr. McCarthy at Northwestern Medicine, Chicago, Illinois, USA, whereby surgeons of varying experience can follow an algorithm to reproducibly achieve mitral valve repair with minimal residual mitral regurgitation and no systolic anterior motion (SAM).

Surgical Technique

As demonstrated in the video, the leaflets were measured, the posterior leaflet was resected and reconstructed to half the length of A2, and then an annuloplasty ring was sized to achieve a coaptation length of 5-10 mm. In this case, leaflet reconstruction was achieved using a measured partial folding plasty. The video also featured a recently FDA-approved annuloplasty device designed to circularize around future transcatheter mitral valve-in-ring devices if needed. The patient presented with severe degenerative mitral regurgitation from P2 flail and underwent successful repair of her valve. Post-repair echocardiography showed a coaptation length aligned with the algorithm’s estimate, no residual regurgitation, and no SAM.

Disclosure

Dr. McCarthy is the inventor of the TransForm ring and receives royalties from Genesee. He is also on the advisory board at Arthrex and is the surgical primary investigator (unpaid) for Abbott’s REPAIR-MR trial.

References

1. McCarthy PM, Herborn J, Kruse J, Liu M, Andrei AC, Thomas JD. A multiparameter algorithm to guide repair of degenerative mitral regurgitation. J Thorac Cardiovasc Surg. 2022;164(3):867-876.e5. doi:10.1016/j.jtcvs.2020.09.129
2. Abicht TO, Andrei AC, Kruse J, McDonald E, Li Z, McCarthy PM. A simple approach to mitral valve repair: posterior leaflet height adjustment using a partial fold of the free edge. J Thorac Cardiovasc Surg. 2014;148(6):2780-2786. doi:10.1016/j.jtcvs.2014.06.075
3. Allen KB, Romary DJ, Grier EA, et al. Bench Testing of a New, Semirigid, Saddle-Shaped, Complete Mitral Annuloplasty Ring Designed to Circularize During Transcatheter Mitral Valve-in-Ring Procedures. Struct Heart. 2025;10(4):100791. Published 2025 Dec 30. doi:10.1016/j.shj.2025.100791

This is the first-place video from the 2026 CTSNet Innovation Video Competition. Watch all entries from the competition, including the runner-up and third place winner. 

Watch for Patrick McCarthy and Daniel Romary’s interview with CTSNet Editor-in-Chief Joel Dunning in the coming weeks.   

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