Complex Cardiovascular Presentations, Standard-Setting Outcomes: A Photo Essay

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Images of mitral valve mastery. Cleveland Clinic heart teams have performed more than 4,200 consecutive mitral valve repairs without an operative death. Left: 3D echocardiogram showing severe mitral valve prolapse with regurgitation. Right: Operating room photo during a robot-assisted mitral valve repair. Robot-assisted surgery has been used for a growing number of repairs of isolated degenerative mitral valve disease at Cleveland Clinic in recent years.

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Maximizing multiarterial CABG. More than a third (34%) of coronary artery bypass graft (CABG) recipients at Cleveland Clinic receive multiple arterial grafts, with overall operative mortality of 0.5%. Left: Coronary angiogram showing severe multivessel coronary disease. Right: Illustration showing total arterial revascularization after CABG.

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Pairing AF ablation and LAA occlusion. Cleveland Clinic is one of the few centers that offer concomitant atrial fibrillation (AF) ablation and implantation of the Watchman™ left atrial appendage (LAA) occlusion device. We do so using 3D intracardiac echo catheter technology to guide device placement instead of conventional transesophageal echo. Left: Intracardiac echo and contrast fluoroscopy images of the LAA before Watchman deployment in a patient undergoing combined AF ablation and LAA occlusion. Right: Intracardiac echo and contrast fluoroscopy images in the same patient after Watchman deployment.

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Unsurpassed aortic valve replacement experience. Cleveland Clinic heart teams have performed more than 15,000 surgical aortic valve replacements in the past 10 years, the most in the U.S. Left: Operative photo of a degenerated, calcified, stenotic aortic valve. Right: Photo of a bioprosthesis in the same patient after surgical aortic valve replacement.

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Standout transplant survival. Heart transplant recipients at Cleveland Clinic have one-year and three-year survival rates of 96% and 94%, respectively, in the latest reporting period. Left: Photo presenting a four-chamber view of a dilated cardiomyopathy specimen from a heart transplant patient. Right: Operative photo of a heart transplant in progress.

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Sparing the valve in aortic root aneurysm repair. In patients with aortic root aneurysm, replacement of the aortic valve with a bioprosthesis risks valve degradation, while replacement with a mechanical prosthesis requires lifelong anticoagulation. To avoid these drawbacks, Cleveland Clinic offers appropriate patients root reimplantation with preservation of the aortic valve. In over 1,200 such operations studied to date, we have achieved >98.4% operative survival and >95% freedom from reoperation. Left: Operative photo of an aneurysm involving the aortic root. Right: Illustration of a completed aortic root replacement with reimplantation.