A Conclave for a Complex Valve

Located between the left atrium and the left ventricle of the heart, the left atrioventricular valve was long ago named the “mitral” valve because it is shaped like a mitre, the tall pointed hat worn by all Roman Catholic bishops, including the Pope. When a pope dies, the College of Cardinals meets in a papal conclave to select a new pope. The word “conclave” is Latin for “with a key,” so named because the electors are supposed to be locked in seclusion and not allowed to leave until a new pope is chosen.

With a nod to that history, “conclave” was the name given to the American Association for Thoracic Surgery’s first-ever meeting devoted entirely to surgery of the mitral valve. The 2011 Mitral Conclave drew more than 1,000 attendees from 66 countries to New York last week. Just as a papal conclave involves the most senior members of the church leadership, attendees at the mitral conclave included the world’s leading experts in mitral valve surgery.

But unlike a papal conclave, in which participants are required to come to a single decision, mitral conclave speakers exhibited a wide array of opinions, approaches, and surgical techniques for repairing the valve. Since the 1983 publication of a landmark article by Dr. Alain F. Carpentier titled “Cardiac Valve Surgery: The French Correction,” repair rather than replacement of the mitral valve has been the gold standard. But repair is far more complicated, program director Dr. David H. Adams told me.

“Mitral valve repair is one of the most interesting and creative operations we do in adult cardiac surgery. Since a typical mitral valve dysfunction is associated with multiple associated valve lesions, a successful repair must utilize techniques that address each of the lesions. It’s not surprising that experts have come up with different ways of repairing the same lesion.”

Current valvular heart disease guidelines from the American College of Cardiology /American Heart Association, and the European Society of Cardiology are based largely on expert opinion rather than evidence from clinical trials. Going forward, studies will need to focus on specific mitral valve etiologic and lesion subgroups, he said.

“Given the complexity of mitral valve disease and the breadth of cardiac surgery, we need specialty meetings where experts can share their experience. Here in New York for 2 days, we’ve seen every major school in the field of mitral valve repair covered. But I think the top surgeons are agreeing more than they’re disagreeing.”

When I asked Dr. Adams about the naming of the meeting as a “conclave” rather than a simple “symposium” or “conference,” he mentioned the link to the bishop’s mitre. But he added, “A ‘conclave’ is a meeting of high importance.”

–Miriam E. Tucker (on Twitter @miriametucker)