When Ietsuna was taken ill his condition became critical around the end of May 1680, he adopted his youngest brother Tsunayoshi MATSUDAIRA, the lord of Tatebayashi Domain and made him the Shogunal successor on the advice of Masatoshi HOTTA, dying shortly after on June 4.
延宝8年（1680年）5月初旬に病に倒れ、危篤状態に陥った家綱は、堀田正俊の勧めを受けて末弟の館林藩主松平綱吉を養子に迎えて将軍後嗣とし、直後の5月8日に死去した。