Percutaneous Transvenous Mitral Annuloplasty

Abstract

Background-Mitral annuloplasty is the most common surgical procedure performed for ischemic mitral regurgitation (MR). Surgical mitral annuloplasty is limited by morbidity, mortality, and MR recurrence. We evaluated the safety and feasibility of a transvenous catheter-delivered implantable device to provide a percutaneous alternative to surgical mitral annuloplasty. Methods and Results-Five patients with chronic ischemic MR underwent percutaneous transvenous implantation of an annuloplasty device in the coronary sinus. Implantation was successful in 4 patients. Baseline MR in the entire group was grade 3.0Ϯ0.7 and was reduced to grade 1.6Ϯ1.1 at the last postimplantation visit when the device was intact or the last postprocedural visit in the patient in whom the device was not successfully implanted. Separation of the bridge section of the device occurred in 3 of 4 implanted devices and was detected at 28 to 81 days after implantation. There were no postprocedural device-related complications. Conclusions-Percutaneous

Noninvasive Evaluation of Coronary Sinus Anatomy and Its Relation to the Mitral Valve Annulus

“…[2][3][4][5] In addition, preliminary results of the first human experience with percutaneous mitral annuloplasty have been described. 6 …”

Innovations in Therapies for Heart Valve Disease

“…60 Commercial development of this technology was pioneered by Edwards Lifesciences ® (Irvine, CA, USA) with the Monarc ® system that consists of two self-expandable stents and a bridge spanning the length between the stents consisting of biodegradable chord. 61 Upon implantation, the chord gradually degrades inducing compression of the spring elements, thus inducing annular compression and reduction in the septal lateral dimension. This device was subsequently followed by the Carillon ® system from Cardiac Dimensions Inc (Kirkland, WA, USA), which consists of two adjustable proximal and distal anchors and a Nitinol ® bridge, which can be progressively shortened during implantation to assess the optimal size for effective reduction of mitral regurgitation.…”

Evolving Concepts and Technologies in Mitral Valve Repair

“…[11][12][13] Some of these devices are now under clinical investigation. [103][104][105] Considering the 1-year failure of conventional annuloplasty when sewn directly on the annulus with a variety of ring types and the complexity of the ischemic MR jet, achieving late success with this approach will be challenging and assumes that the patient has coronary anatomy that will allow the operator to place the device. Although success in animals has been obtained, human trials have presented more difficulties.…”