Development of a Simultaneous Cryo-Anchoring and Radiofrequency Ablation Catheter for Percutaneous Treatment of Mitral Valve Prolapse

Boronyak, Steven M.; Merryman, W. David

doi:10.1007/s10439-012-0571-y

Cited by 18 publications

(14 citation statements)

References 39 publications

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“…This difference in radial shrinkage (12%) and circumferential shrinkage (30%) is due to the preferred alignment of collagen with the circumferential direction and is consistent with previous ex vivo findings in a static environment. 2 Based on the ex vivo data, the target for in vivo RFC catheter treatment efficacy is approximately 10% reduction in leaflet length, which would indicate a total leaflet area reduction of approximately 40% (Fig. 3D).…”

Section: Discussionmentioning

confidence: 99%

“…To determine reductions in marker area, circumferential length, and radial length, the deformation gradient tensor was calculated from the four marker positions and averaged over three repeated measurements (MATLAB, MathWorks, Inc.). 2, 12 After the first five ablations to the AL, the AL and posterior leaflet (PL) were both ablated up to 10 times, and post-treatment echocardiographic recordings were captured. AL and PL lengths were measured during mid-diastole, from the base of the annulus to the leaflet free edge, and averaged over three measurements (MATLAB) (Fig.…”

Section: Methodsmentioning

confidence: 99%

“…Values shown to the right are the corresponding estimates of resected leaflet area based on treated and untreated controls in a static bench environment. 2, 3 C: Representative picrosirius red stained section demonstrating the typical loss of collagen crimp following thermal shrinkage (Animal #1). An untreated control is shown on the right.…”

Section: Figurementioning

confidence: 99%

“…The RFC catheter uses intraluminal delivery of pressurized nitrous oxide to cool a catheter tip to temperatures between −50°C and −20°C to provide stable and reversible catheter adhesion to moving MV leaflets without negatively restricting leaflet motion or altering leaflet structure. 2, 3 RF energy delivery to an RF electrode on the catheter is then used to thermally shrink, or resect, enlarged and myxomatous leaflet tissue by heating collagen to temperatures greater than 65°C, 16, 17 and RF energy has been shown to reduce leaflet size by up to 45% in a static bench environment. 2 …”

Section: Introductionmentioning

confidence: 99%

“…2, 3 RF energy delivery to an RF electrode on the catheter is then used to thermally shrink, or resect, enlarged and myxomatous leaflet tissue by heating collagen to temperatures greater than 65°C, 16, 17 and RF energy has been shown to reduce leaflet size by up to 45% in a static bench environment. 2 …”

Section: Introductionmentioning

confidence: 99%

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Quantitative Imaging Assessment of an Alternative Approach to Surgical Mitral Valve Leaflet Resection: An Acute Porcine Study

et al. 2015

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This study reports the initial in vivo use of a combined radiofrequency ablation and cryo-anchoring (RFC) catheter as an alternative to surgical mitral valve (MV) leaflet resection. Radiofrequency ablation thermally shrinks enlarged collagenous tissues, providing an alternative to leaflet resection, and cryo-anchoring provides reversible attachment of a catheter to freely mobile MV leaflets. Excised porcine MVs (n=9) were tested in a left heart flow simulator to establish treatment efficacy criteria. Resected leaflet area was quantified by tracking markers on the leaflet surface, and leaflet length reductions were directly measured on echocardiography. Leaflet area decreased by 38 ± 2.7%, and leaflet length decreased by 9.2 ± 1.8% following RFC catheter treatment. The RFC catheter was then tested acutely in healthy pigs (n=5) under epicardial echocardiographic guidance, open-chest without cardiopulmonary bypass, using mid-ventricular free wall access. Leaflet length was quantified using echocardiography. Quantitative assessment of MV leaflet length revealed that leaflet resection was successful in 4 of 5 pigs, with a leaflet length reduction of 13.3 ± 4.6%. Histological, mechanical, and gross pathological findings also confirmed that RFC catheter treatment was efficacious. The RFC catheter significantly reduces MV leaflet size in an acute animal model, providing a possible percutaneous alternative to surgical leaflet resection.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Figurementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Quantitative Imaging Assessment of an Alternative Approach to Surgical Mitral Valve Leaflet Resection: An Acute Porcine Study

et al. 2015

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Measurement Technologies for Heart Valve Function

Jensen

Siefert

Okafor

et al. 2018

Advances in Heart Valve Biomechanics

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Transcatheter Mitral Valve Repair Therapies: Evolution, Status and Challenges

et al. 2016

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Mitral regurgitation is a common cardiac valve lesion, developing from primary lesions of the mitral valve or secondary to cardiomyopathies. Moderate or higher severity of mitral regurgitation imposes significant volume overload on the left ventricle, causing permanent structural and functional deterioration of the myocardium and heart failure. Timely correction of regurgitation is essential to preserve cardiac function, but surgical mitral valve repair is often delayed due to the risks of open heart surgery. Since correction of mitral regurgitation can provide symptomatic relief and halt progressive cardiac dysfunction, transcatheter mitral valve repair technologies are emerging as alternative therapies. In this approach, the mitral valve is repaired either with sutures or implants that are delivered to the native valve on catheters introduced into the cardiovascular system under image guidance, through small vascular or ventricular ports. Several transcatheter mitral valve technologies are in development, but limited clinical success has been achieved. In this review, we present a historical perspective of mitral valve repair, review the transcatheter technologies emerging from surgical concepts, the challenges they face in achieving successful clinical application, and the increasing rigor of safety and durability standards for new transcatheter valve technologies.

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Development of a Simultaneous Cryo-Anchoring and Radiofrequency Ablation Catheter for Percutaneous Treatment of Mitral Valve Prolapse

Cited by 18 publications

References 39 publications

Quantitative Imaging Assessment of an Alternative Approach to Surgical Mitral Valve Leaflet Resection: An Acute Porcine Study

Quantitative Imaging Assessment of an Alternative Approach to Surgical Mitral Valve Leaflet Resection: An Acute Porcine Study

Measurement Technologies for Heart Valve Function

Transcatheter Mitral Valve Repair Therapies: Evolution, Status and Challenges

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