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When Anatomy Says No: Redefining Mitral Valve Intervention at Atlantic Health Morristown Medical Center
November 2, 2026 | Gennaro Giustino, MD, a structural interventional cardiologist at Atlantic Health Morristown Medical Center, specializes in advanced structural heart interventions for patients with complex valvular disease, including recurrent mitral regurgitation after prior surgical repair.
The article examines the objective, findings, and clinical context described in When Anatomy Says No: Redefining Mitral Valve Intervention at Atlantic Health Morristown Medical Center.
Approach:
Transcatheter electrosurgery: The article describes percutaneous techniques for tissue modification, traversal, or laceration. LAMPOON involves lacerating the anterior mitral leaflet to reduce the risk of left ventricular outflow tract obstruction during transcatheter mitral valve replacem…
Case example: A patient with severe recurrent mitral regurgitation after robotic repair was considered inoperable for redo surgery. The team combined LAMPOON with laceration of a prior Alfieri stitch and used preemptive ECMO before leaflet modification.
Program experience: The center reports performing 30–40 leaflet modification procedures annually across the aortic, mitral, and tricuspid valves.
Key Findings:
The patient was decannulated from ECMO within days and was reported to remain well at follow-up.
The article identifies recurrent mitral regurgitation after repair, severe regurgitation with elevated pulmonary pressures, anatomy raising concern for obstruction, and high surgical risk as reasons for structural evaluation.
Interpretation:
The article presents transcatheter electrosurgery, including leaflet and stitch laceration, as an option for selected patients whose prior repair or anatomy complicates transcatheter mitral valve replacement.
Limitations:
The article describes one patient case and does not provide comparative outcomes or detailed follow-up data.
The reported annual procedure volume is not accompanied by outcome measures.
Conclusion:
The article describes a multidisciplinary, high-volume structural heart program and notes that early consultation can clarify candidacy, strategy, and timing without committing a patient to intervention.
November 3, 2026 | Gennaro Giustino, MD, structural interventional cardiologist at Atlantic Health, describes the UNICORN technique as a strategy used selectively in patients whose anatomy raises concern.
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