scholarly journals A Deployable Transseptal Brace for Stabilizing Cardiac Catheters

2018 ◽  
Vol 140 (7) ◽  
Author(s):  
Leah P. Gaffney ◽  
Paul M. Loschak ◽  
Robert D. Howe
Keyword(s):  
Mitral Valve ◽  
Minimally Invasive ◽  
Surgical Procedures ◽  
Interatrial Septum ◽  
Valve Repair ◽  
Cardiac Catheters ◽  
Folding Structure ◽  
Cardiac Valve Disease ◽  
Complex Surgical Procedures ◽  
Minimally Invasive Instruments

A bracing device for stabilizing cardiac catheters inside the heart was developed to provide surgical-level dexterity to minimally invasive catheter-based procedures for cardiac valve disease. The brace was designed to have a folding structure, which lies flat along a catheter during navigation through vasculature and then unfolds into a rigid bracing configuration after deployment across the interatrial septum. The brace was designed to be easily deployable, provide bracing support for a transseptal catheter, and also be compliant enough to be delivered to the heart via tortuous vasculature. This aims to improve dexterity in catheter-based mitral valve repair and enable other complex surgical procedures to be done with minimally invasive instruments.

scholarly journals DL-based segmentation of endoscopic scenes for mitral valve repair

2020 ◽  
Vol 6 (1) ◽  
Author(s):  
Matthias Ivantsits ◽  
Lennart Tautz ◽  
Simon Sündermann ◽  
Isaac Wamala ◽  
Jörg Kempfert ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Minimally Invasive ◽  
Mitral Valve Repair ◽  
Video Stream ◽  
Field Of View ◽  
Valve Repair ◽  
Distance Measurements ◽  
Anatomical Structures ◽  
Endoscopic Video ◽  
Camera Position

AbstractMinimally invasive surgery is increasingly utilized for mitral valve repair and replacement. The intervention is performed with an endoscopic field of view on the arrested heart. Extracting the necessary information from the live endoscopic video stream is challenging due to the moving camera position, the high variability of defects, and occlusion of structures by instruments. During such minimally invasive interventions there is no time to segment regions of interest manually. We propose a real-time-capable deep-learning-based approach to detect and segment the relevant anatomical structures and instruments. For the universal deployment of the proposed solution, we evaluate them on pixel accuracy as well as distance measurements of the detected contours. The U-Net, Google’s DeepLab v3, and the Obelisk-Net models are cross-validated, with DeepLab showing superior results in pixel accuracy and distance measurements.

scholarly journals Minimally-invasive mitral valve repair of symmetric and asymmetric Barlow´s disease

2021 ◽  
Author(s):  
Gloria Faerber ◽  
Sophie Tkebuchava ◽  
Mahmoud Diab ◽  
Christian Schulze ◽  
Michael Bauer ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Minimally Invasive ◽  
Wide Spectrum ◽  
Mitral Valve Surgery ◽  
Valve Repair ◽  
Prolapse Repair ◽  
Repair Rate ◽  
Barlow’S Disease ◽  
Increased Risk

Abstract Objectives Barlow´s disease represents a wide spectrum of mitral valve pathologies associated with regurgitation (MR), excess leaflet tissue, and prolapse. Repair strategies range from complex repairs with annuloplasty plus neochords through resection to annuloplasty-only. The latter requires symmetric prolapse patterns and central regurgitant jets. We aimed to assess repair success and durability, survival, and intraoperative outcomes with symmetric and asymmetric Barlow’s disease. Methods Between 09/10 and 03/20, 103 patients (of 1939 with mitral valve surgery) presented with Barlow´s disease. All received surgery through mini-thoracotomy with annuloplasty plus neochords (n = 71) or annuloplasty-only (n = 31). One valve was replaced for endocarditis (repair rate: 99%). Results Annuloplasty-only patients were older (64 ± 16 vs. 55 ± 11 years, p = 0.008) and presented with higher risk (EuroSCORE II: 4.2 ± 4.9 vs. 1.6 ± 1.7, p = 0.007). Annuloplasty-only patients had shorter cross-clamp times (53 ± 18 min vs. 76 ± 23 min, p < 0.001) and received more tricuspid annuloplasty (15.5% vs. 48.4%, p < 0.001). Operating times were similar (170 ± 41 min vs. 164 ± 35, p = 0.455). In three patients, annuloplasty-only caused intraoperative systolic anterior motion (SAM), which was fully resolved by neochords to the posterior leaflet. There were no conversions to sternotomy or deaths at 30-days. Three patients required reoperation for recurrent MR (at 25 days, 2.8 and 7.8 years). At the latest follow-up, there was no MR in 81.4%, mild in 14.7%, and moderate in 2.9%. Three patients died due to non-cardiac reasons. Surviving patients report the absence of relevant symptoms. Conclusions Minimally-invasive Barlow’s repair is safe with good durability. Annuloplasty-only may be a simple solution for complex but symmetric pathologies. However, it may carry an increased risk of intraoperative SAM.

scholarly journals Sequential Venous Percutaneous Transluminal Angioplasty and Balloon Dilatation of the Interatrial Septum during Percutaneous Edge-to-Edge Mitral Valve Repair

2017 ◽  
Vol 2017 ◽  
pp. 1-3
Author(s):  
Rezo Jorbenadze ◽  
Johannes Patzelt ◽  
Meinrad Gawaz ◽  
Peter Seizer ◽  
Harald F. Langer
Keyword(s):  
Mitral Valve ◽  
Mitral Valve Repair ◽  
Percutaneous Transluminal Angioplasty ◽  
Balloon Dilatation ◽  
Mitral Valve Regurgitation ◽  
Interatrial Septum ◽  
Transluminal Angioplasty ◽  
Valve Regurgitation ◽  
Valve Repair ◽  
Percutaneous Transluminal

Percutaneous edge-to-edge mitral valve repair (PMVR) is widely used for selected, high-risk patients with severe mitral valve regurgitation (MR). This report describes a case of 81-year-old woman presenting with severe and highly symptomatic mitral valve regurgitation (MR) caused by a flail of the posterior mitral valve leaflet (PML). PMVR turned out to be challenging in this patient because of a stenosis and tortuosity of both iliac veins as well as sclerosis of the interatrial septum, precluding the vascular and left atrial access by standard methods, respectively. We managed to achieve atrial access by venous percutaneous transluminal angioplasty (PTA) and balloon dilatation of the interatrial septum. Subsequently, we could advance the MitraClip® system to the left atrium, and deployment of the clip in the central segment of the mitral valve leaflets (A2/P2) resulted in a significant reduction of MR.

scholarly journals Minimally invasive mitral valve repair and ablation of concomitant atrial fibrillation in a patient with severe hemophilia A

2020 ◽  
Author(s):  
Alexander Bogachev Prokophiev ◽  
Ravil Sharifulin ◽  
Anastasiia Karadzha ◽  
Natalya Larionova ◽  
Vladimir Shmyrev ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Mitral Valve ◽  
Minimally Invasive ◽  
Mitral Valve Repair ◽  
Hemophilia A ◽  
Severe Hemophilia ◽  
Valve Repair

scholarly journals Minimally invasive mitral valve surgery. An anesthesiologist''s viewpoint

2015 ◽  
Vol 17 (2) ◽  
pp. 11 ◽  
Author(s):  
V. A. Shmyrev ◽  
A. V. Bogachev-prokofev ◽  
V. V. Lomivorotov ◽  
D. N. Ponomarev ◽  
P. P. Perovskiy
Keyword(s):  
Mitral Valve ◽  
Minimally Invasive ◽  
Fatal Outcome ◽  
Median Sternotomy ◽  
Group Versus ◽  
Mitral Valve Surgery ◽  
Control Group ◽  
Complication Rates ◽  
Valve Repair ◽  
Invasive Group

We conducted a retrospective comparative analysis of 75 patients undergoing video-assisted mitral valve repair with right minithoracotomy over a period from November 2011 to August 2013. The control group comprised 71 patients operated on mitral valve by using median sternotomy during the same period. Median (25th; 75th) times of cardiopulmonary bypass and aortic cross-clamping were significantly longer in the minimally invasive group (180 [139; 224] and 111 [87; 145] min, respectively) as compared to the controls (84 [69; 117] and 62 [49; 81 ] min, respectively), p<0.01. Fatal outcome occurred in 2 (2.7%) cases in the minimally invasive group versus none in the controls. In both cases death resulted from intraoperative aortic dissection. While ventilation time and intensive care unit stay were comparable across the groups, postoperative respiratory failure occurred in 6 (8%) cases in the minimally invasive group versus none in the controls (p<0.05). No other significant differences in the postoperative course were observed between the groups. The results of the present study are generally consistent with the world's tendencies. On the other hand, complication rates observed in the minimally invasive group present a considerable economic burden and require substantial human resources in the postoperative period.

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