TY - JOUR
T1 - A Novel Method of Percutaneous Mitral Valve Repair for Ischemic Mitral Regurgitation
AU - Sorajja, Paul
AU - Nishimura, Rick A.
AU - Thompson, Jess
AU - Zehr, Kenton
N1 - Funding Information:
Funding for this study was provided entirely by St. Jude Medical Inc. Cardiac Technologies Group. The sponsor had full access to the data and preparation of the manuscript. Dr. Sorajja has served as a consultant to St. Jude Medical Inc. Cardiac Technologies Group. Dr. Zehr is a patent holder and has a royalty agreement with the technology described in this investigation.
PY - 2008/12
Y1 - 2008/12
N2 - Objectives: This investigation sought to determine the feasibility of a novel method of a percutaneous mitral valve repair. Background: Percutaneous mitral valve repair has emerged as an alternative therapy for patients with functional mitral regurgitation. However, current methods that rely on cannulation of the coronary sinus may not result in direct reduction of the mitral annulus area due to the superior relationship of the sinus to the annulus. Methods: A novel device, consisting of helical stainless steel screws connected by a biocompatible tether, was designed for percutaneous mitral valve repair. This device was implanted by implanting the helical screws directly into the myocardium at the posteromedial mitral annulus of 8 anesthetized pigs from the right internal jugular vein. Results: Implantation of the device resulted in a 19.7 ± 0.1% reduction in mitral annular area and an 18.8 ± 0.1% decrease in the mitral anterior-posterior dimension (both p < 0.05 vs. baseline). This annular reduction persisted at 3-month follow-up. Both the coronary sinus and left circumflex coronary artery remained patent in all animals. There was no evidence of device migration, poor wound healing, or tissue thrombosis at the sites of device implantation. Conclusions: Percutaneous mitral valve repair targeting the ventricular myocardium from central venous access is feasible. By directly acting on the posteromedial mitral annulus, this methodology targets the mitral annular area most frequently affected by ischemic mitral regurgitation, lessens the risk of coronary artery impingement, promotes coronary sinus patency, and overcomes technical concerns that may arise when the coronary sinus lies significantly superior to the mitral annulus.
AB - Objectives: This investigation sought to determine the feasibility of a novel method of a percutaneous mitral valve repair. Background: Percutaneous mitral valve repair has emerged as an alternative therapy for patients with functional mitral regurgitation. However, current methods that rely on cannulation of the coronary sinus may not result in direct reduction of the mitral annulus area due to the superior relationship of the sinus to the annulus. Methods: A novel device, consisting of helical stainless steel screws connected by a biocompatible tether, was designed for percutaneous mitral valve repair. This device was implanted by implanting the helical screws directly into the myocardium at the posteromedial mitral annulus of 8 anesthetized pigs from the right internal jugular vein. Results: Implantation of the device resulted in a 19.7 ± 0.1% reduction in mitral annular area and an 18.8 ± 0.1% decrease in the mitral anterior-posterior dimension (both p < 0.05 vs. baseline). This annular reduction persisted at 3-month follow-up. Both the coronary sinus and left circumflex coronary artery remained patent in all animals. There was no evidence of device migration, poor wound healing, or tissue thrombosis at the sites of device implantation. Conclusions: Percutaneous mitral valve repair targeting the ventricular myocardium from central venous access is feasible. By directly acting on the posteromedial mitral annulus, this methodology targets the mitral annular area most frequently affected by ischemic mitral regurgitation, lessens the risk of coronary artery impingement, promotes coronary sinus patency, and overcomes technical concerns that may arise when the coronary sinus lies significantly superior to the mitral annulus.
KW - annuloplasty
KW - mitral regurgitation
KW - percutaneous
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U2 - 10.1016/j.jcin.2008.07.008
DO - 10.1016/j.jcin.2008.07.008
M3 - Article
C2 - 19463382
AN - SCOPUS:57549117238
SN - 1936-8798
VL - 1
SP - 663
EP - 672
JO - JACC: Cardiovascular Interventions
JF - JACC: Cardiovascular Interventions
IS - 6
ER -