Alfieri stitch and its impact on mitral clip

Alfieri, Ottavio; Denti, Paolo

doi:10.1016/j.ejcts.2011.01.017

Cited by 30 publications

(18 citation statements)

References 8 publications

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“…Autopsy revealed that the ventricular helix part had not correctly encircled all tendinous cords underlining the mode of action of the MAR system, namely the narrowing and stabilizing of the valve entrance and guidance of the chordae tendineae. The latter shows similarities to the concept of the Alfieri stitch [10]. …”

Section: Discussionmentioning

confidence: 65%

Comparison of the novel Medtentia double helix mitral annuloplasty system with the Carpentier-Edwards Physio annuloplasty ring: morphological and functional long-term outcome in a mitral valve insufficiency sheep model

Konerding

Simpanen

Ihlberg

et al. 2013

J Cardiothorac Surg

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BackgroundThe prevalence of mitral regurgitation in cardiac diseases requires annuloplasty systems that can be implanted without excessive patient burden. This study was designed to examine the morphological and functional outcome of a new double helix mitral annuloplasty ring in an ovine model in comparison to the classical Carpentier-Edwards (CE) annuloplasty ring as measured by reduction of mitral regurgitation and tissue integration. The Medtentia annuloplasty ring (MAR) is a helical device that is rotated into the annulus self-restoring the valve geometry, enabling a faster fixation without the need of elaborate repair of the valve geometry. The ventricular part of the helical ring encircles the valve chords.MethodsTwenty adult sheep were overpaced until 2+ level mitral valve regurgitation was achieved. Seven animals per group received either the MAR or the CE ring. Implantation was performed on-pump in a beating heart through the left atrial appendix. The animals were sacrificed 3.6 ± 0.3 months after surgery following an echocardiography for assessing mitral regurgitation as primary endpoint. The annuloplasty rings with surrounding tissue were harvested for histological analyses as secondary endpoints. The remaining six sheep received the MAR system and were sampled seven, nine or 12 months after surgery.ResultsImplantation time (p < 0.01) and perfusion time (p < 0.001) as clinical secondary endpoints were significantly shorter in the MAR group. Echocardiography follow-ups showed sufficient valve function repair in nearly all animals with a normalization of the ventricle diameters in both groups (group difference: p = 0.147). The weights of the hearts did not differ significantly. Histology revealed adequately covered atrial annuloplasty rings with functional endothelium and lack of excessive granulation tissue or fibrosis in all specimens. The ventricular projections of the MAR systems encircling the chordae tendineae were not completely covered with neointimal tissue, although in no case were microthrombi detected and no thromboembolic events were recorded.ConclusionsThe new MAR system is an easy to use annuloplasty system with a functional outcome comparable to that of the well–proven CE ring. Mitral valve regurgitation is effectively stopped both by restricting the pathological expansion of the annulus and by gathering the chords without thrombus formation.

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Section: Discussionmentioning

confidence: 65%

Comparison of the novel Medtentia double helix mitral annuloplasty system with the Carpentier-Edwards Physio annuloplasty ring: morphological and functional long-term outcome in a mitral valve insufficiency sheep model

Konerding

Simpanen

Ihlberg

et al. 2013

J Cardiothorac Surg

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show abstract

“…However, in elderly patients with fMR, the MitraClip improved the primary end point of freedom from death, mitral valve surgery, and grade 3+ or 4+ MR compared with annuloplasty [91]. This result may indicate that some MR reduction can provide meaningful clinical benefits in fMR [92].…”

Section: Other Experimental Ventricular Proceduresmentioning

confidence: 62%

Surgical Approach to Mitral Regurgitation in Chronic Heart Failure: When Is It an Option?

Crestanello

2011

Curr Heart Fail Rep

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Functional mitral regurgitation (MR) is common in patients with chronic heart failure and adversely affects survival and quality of life. Surgery is effective in improving symptoms and reverse remodeling of the ventricle. However, its effect on survival is unclear. Indications for surgery are challenging given the elevated surgical risk of these patients, lack of prospective randomized data, and uncertain long-term results in the historical series. A systematic approach to functional mitral regurgitation that addresses both the mitral insufficiency and the ventricular remodeling with careful patient selection can achieve reliable, reproducible, and lasting results. This article reviews the surgical procedures to treat functional mitral regurgitation and presents an algorithm for their application in patients with congestive heart failure.

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“…On se temelji na kirurπkoj tehnici Alfieri stich, rekonstrukcija edge-to-edge (Slika 2). 19 MitraClip sustav se sastoji od katetera kroz koji se plasira "kvaËica" te sustava uvoenja "kvaËice" koji ukljuËuje odvojivu "kvaËicu" s dakronskim pokrovom koji omoguÊuje urastanje tkiva. Sustav uvoenja "kvaËice" sadraei i kontrolni mehanizam za otvaranje i zatvaranje dva kraka "kvaËice".…”

Section: Intervencije Na Mitralnom Zaliskuunclassified

“…It is based on the surgical Alfieri stitch technique, an edge-to-edge repair (Figure 2). 19 The MitraClip system consists of a catheter to guide the path of the clip delivery and a clip delivery system which includes the detachable clip with a Dacron cover to enable tissue ingrowth. The clip delivery system has a control mechanism to open and close the two arms of the clip.…”

Section: Mitral Valve Interventionsmentioning

confidence: 99%

Almanac 2013: novel non-coronary cardiac interventions

Meier

Franzen²,

Lansky³

2013

Cardiol Croat.

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SAAEETAK:Aktualne inovacije u intervencijskoj kardiologiji dramatiËno su proπirile terapijske moguÊnosti za srËa-ne bolesnike. Intervencijska kardiologija viπe nije ograniËena na lijeËenje koronarne bolesti srca veÊ je moguÊe lijeËiti bolesti zalistaka, raditi na prevenciji moaedanog udara, lijeËenju arterijske hipertenzije, itd. Jedna od najvaaenijih novih moguÊnosti lijeËenja je perkutano lijeËenje aortne stenoze (transkateterska implantacija aortne valvule), buduÊi da je bolest aortne valvule vrlo Ëest problem u bolesnika starije aeivotne dobi, a mnogi od njih imaju visok rizik od operacije. Isto tako, mitralna regurgitacija je Ëesto povezana s pojavom komorbiditeta koji Ëine operaciju visokoriziËnom. MitraClip je obeÊavajuÊe perkutano alternativno rjeπenje za kirurπki popravak ili zamjenu srËanog zaliska. Ostali postupci koji se spominju u ovom preglednom Ëlanku su perkutano zatvaranje aurikule lijevog atrija kao nefarmakoloπka terapija za prevenciju moaedanog udara, renalna denervacija za rezistentnu arterijsku hipertenziju. U ovom se Ëlanku pojaπnjavaju osnovni principi ovih postupaka, najvaaenije kliniËke studije uz dodatne kliniËke podatke o svakom od njih. KLJU»NE RIJE»I: intervencijska kardiologija, intervencijski zahvati na zaliscima. SUMMARY:Recent innovations in interventional cardiology have dramatically expanded the therapeutic options for patients with cardiac conditions. Interventional cardiology is no longer limited to the treatment of coronary artery disease but allows also treatment of valvular disease, stroke prevention, hypertension, etc. One of the most important new treatment options is the percutaneous treatment for aortic valve stenosis (transcatheter aortic valve implantation), since aortic valve disease is a rather common problem in elderly patients, with many of them at high risk for surgery. Similarly, mitral regurgitation is often associated with comorbidities which make surgery high risk. The MitraClip is a promising percutaneous alternative to surgical valve repair or replacement. Other procedures discussed in this review are the percutaneous left atrial appendage closure as a non-pharmacologic therapy to prevent strokes, and renal denervation for resistant hypertension. This review explains the basic principles of these procedures, the most important clinical evidence, and also provides additional recent clinical data on each of these them.

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Alfieri stitch and its impact on mitral clip

Cited by 30 publications

References 8 publications

Comparison of the novel Medtentia double helix mitral annuloplasty system with the Carpentier-Edwards Physio annuloplasty ring: morphological and functional long-term outcome in a mitral valve insufficiency sheep model

Comparison of the novel Medtentia double helix mitral annuloplasty system with the Carpentier-Edwards Physio annuloplasty ring: morphological and functional long-term outcome in a mitral valve insufficiency sheep model

Surgical Approach to Mitral Regurgitation in Chronic Heart Failure: When Is It an Option?

Almanac 2013: novel non-coronary cardiac interventions

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