Clamping the mitral and tricuspid annuli with bipolar devices

n/

Reply to the Editor

n/

Amplatzer device migration through the sternum: A rare complication of percutaneous treatment for an aortic pseudoaneurysm solved by 2 length-adjustable bovine pericardium conduits

n/

Large left ventricular aneurysm

n/

Mitral leaflet anatomy revisited

ObjectiveThe aims of this work were to employ functional imaging capabilities of the Visible Heart laboratory and endoscopic visualization of mitral valves in perfusion-fixed specimens to better characterize variability in mitral valve leaflet anatomy and to provide a method to classify mitral leaflets that varies from the current nomenclature.MethodsWe gathered functional endoscopic video footage (11 isolated reanimated human hearts) and static endoscopic anatomical images (38 perfusion-fixed specimens) of mitral leaflets. Commissure and cleft locations were charted using Carpentier's accepted description.ResultsAll hearts had 2 commissures separating anterior and posterior leaflets. “Standard” clefts separating P1/P2 were found in 66% of hearts (n = 25), and standard clefts separating P2/P3 were present in 71% of hearts (n = 27). “Deviant” clefts occurred in each region of the anterior leaflet (A1, A2, A3), and their relative occurrences were 5%, 8%, and 13% (n = 2, 3, 5), respectively. Deviant clefts were found in posterior leaflets: 13.2% in P1 (n = 5), 32% in P2 (n = 12), and 21% in P3 (n = 8).ConclusionsHumans elicit complex and highly variable mitral valve anatomy. We suggest a complementary, yet simple nomenclature to address variation in mitral valve anatomy by describing clefts as either standard or deviant and locating regions in which they occur (A1 to A3 or P1 to P3)

Midterm results of edge-to-edge mitral valve repair without annuloplasty

n/

Direct access transcatheter mitral annuloplasty with a sutureless and adjustable device: preclinical experience†

OBJECTIVES The aim of the study was to evaluate the technical feasibility and performance of a transcatheter mitral annuloplasty system. METHODS Adult swines (n=15) underwent left thoracotomy through the 4th-5th intercostal space. A transcatheter device (CardioBand, Valtech-Cardio Ltd) was introduced through an 18F sheath through the left atrium and attached to the annulus between the posterior and anterior commissures using echocardiographic and fluoroscopic guidance, on the beating heart. The sutureless device was implanted using a steerable delivery system to deploy sequential fixation elements. Following implantation, the device length was adjusted on the beating heart to reduce the intercommissural and septolateral dimension, under echocardiographic guidance. Finally, the flexible adjustment tool was withdrawn from the working sheath and the atrial purse-string closed. All but five animals were sacrificed acutely by intent, while the others were sacrificed at 90 days. RESULTS All animals survived the acute implant. One animal died at the third post-operative day due to bleeding. The annuloplasty system was successfully implanted in all animals. A mean of 12±3 fixation elements were deployed. The band length was reduced up to 20% after implantation in each animal. At necropsy, the location of the implant was within a few millimetres of the annulus (3.5±4mm). In three animals, fixation elements were implanted inadvertently in the leaflets, but no coronary lesions were observed. All animals survived the acute implant. One animal died on the third post-operative day due to bleeding. In the four long-term survivors, the implanted annuloplasty device showed satisfactory healing and no ring dehiscence. CONCLUSIONS Transcatheter minimally invasive, beating-heart implantation of an adjustable annuloplasty band is feasible in the animal model. This approach may be an alternative to open surgical procedures in high-risk patient