Modeling the Interaction Between the Coronary Sinus and the Proximal Anchor Stent in Percutaneous Transvenous Mitral Annuloplasty

2010 ◽  
Author(s):  
Wei Sun ◽  
Milton DeHerrera
Keyword(s):  
Mitral Regurgitation ◽  
Coronary Sinus ◽  
Mitral Annulus ◽  
Functional Mitral Regurgitation ◽  
Computational Tools ◽  
Mitral Annuloplasty ◽  
Quantitative Understanding ◽  
Valve Annulus ◽  
Implanted Device ◽  
Anterior Posterior

Surgical treatment of severe functional mitral regurgitation (MR) often involves mitral annuloplasty, a procedure where a flexible or rigid annuloplasty ring is used to downsize the dilated mitral valve annulus (MA) and improve leaflet apposition by posterior annular correction. Recently various minimally invasive percutaneous transvenous mitral annuloplasty (PTMA) devices have been tested in patients who are not suitable candidates for a surgical procedure involving a thoracotomy. The approach is based on the concept that by utilizing the parallel location of the coronary sinus (CS) to the mitral annulus, a device, that can reshape the annulus, can be percutaneously deployed within the coronary sinus (CS) and the great cardiac vein (GCV). When the implanted device deforms, it shortens the MA anterior-posterior dimension and decreases mitral regurgitation (MR) (Fig. 1). Although the approach has been shown to be promising, PTMA device dysfunction and fatigue fracture have been reported in several firstin-human clinical trials (1). We hypothesize that quantitative understanding of the biomechanical interaction between the venous tissue, the mitral improve the efficacy of the PTMA treatment of MR. In this study, we aim to model interactions between the PTMA proximal anchor and the CS using computational tools.

Percutaneous Mitral Annuloplasty for Treatment of Functional Mitral Regurgitation

2009 ◽  
Vol 5 (1) ◽  
pp. 67
Author(s):  
Lutz Buellesfeld ◽  
Lazar Mandinov ◽  
Eberhard Grube ◽  
◽  
◽  
...  
Keyword(s):  
Mitral Regurgitation ◽  
Coronary Sinus ◽  
Standard Of Care ◽  
Mitral Annulus ◽  
Functional Mitral Regurgitation ◽  
Invasive Treatment ◽  
Large Variability ◽  
Mitral Annuloplasty ◽  
Number Of Patients ◽  
Anatomical Relationship

Functional mitral regurgitation affects a substantial proportion of patients with congestive heart failure due to myocardial infarction or dilated cardiomyopathy. Functional mitral regurgitation greatly increases morbidity and mortality. Surgical annuloplasty is the standard of care for symptomatic patients with moderate or severe functional mitral regurgitation; however, a large number of patients are refused surgery. Several percutaneous approaches have been developed to address the need for less invasive treatment of mitral annulus dilatation. Devices using coronary sinus to cinch the mitral annulus are relatively easy to use; however, a number of factors may limit their clinical application, such as suboptimal anatomical relationship between the coronary sinus and mitral annulus, risk of coronary artery compression, large variability in the coronary venous anatomy and conflict with other therapies such as ablation or cardiac resynchronisation. Direct mitral annuloplasty is anticipated to be more effective than the coronary sinus approaches; however, it has yet to prove its safety and efficacy in carefully designed clinical trials. The best candidates and the best timing for each percutaneous mitral annuloplasty therapy, whether direct or indirect, have yet to be identified.

Simulated Deployment of Percutaneous Transvenous Mitral Annuloplasty Device Into Human Coronary Sinus Vessel

2011 ◽  
Author(s):  
Thuy M. Pham ◽  
Qian Wang ◽  
Milton DeHerrera ◽  
Wei Sun
Keyword(s):  
Coronary Sinus ◽  
Ventricular Dysfunction ◽  
Surgical Repair ◽  
Critical Role ◽  
Cost Effective ◽  
Mitral Annulus ◽  
Left Ventricular ◽  
Functional Mitral Regurgitation ◽  
Patient Specific ◽  
Mitral Annuloplasty

Functional mitral regurgitation (MR) is the consequence of left ventricular dysfunction occurring after ischemic heart disease and often has poor prognosis. Surgical repair and replacement of the mitral valve are currently being used to treat severe functional MR However, the technique carries high mortality rate [1] and is not suitable for patients with comorbidities and advanced age [2]. Recently, a new non-surgical intervention, percutaneous transvenous mitral annuloplasty (PTMA), is emerging as an attractive endovascular alternative that is less invasive, less recovery time, and cost effective. The device is delivered percutaneously into the coronary sinus (CS) vessel and once embedded, it contracts and shortens the septo-lateral distance of the mitral annulus, hence improve MR. However, despite of its feasibility, current clinical trials reported severe adverse events, such as device fracture [3]. The biomechanical interaction between the CS wall and the stent plays a critical role in the outcome of the deployment and the device performance. In this study, we proposed to analyze this interaction by developing Finite Element (FE) models of the CS vessel and the PTMA anchors and analyzing the peak stresses, strains, interaction forces (shear, normal) after the deployment of the proximal and distal anchors into a realistic patient-specific CS model.

Abstract 3052: Initial Human Experiences with a Non-Stented Coronary Sinus Device for the Treatment of Functional Mitral Regurgitation in Heart Failure Patients

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Stefan Sack ◽  
Philipp Kahlert ◽  
Luc Bilodeau ◽  
Luc Pierard ◽  
Patrizio Lancellotti ◽  
...  
Keyword(s):  
Heart Failure ◽  
Mitral Regurgitation ◽  
Coronary Sinus ◽  
Diagnostic System ◽  
Mitral Annulus ◽  
Functional Mitral Regurgitation ◽  
Heart Failure Patients ◽  
Percutaneous Mitral Valve Repair ◽  
Permanent Implant ◽  
Diagnostic Catheter

Recently, several approaches have been developed for percutaneous mitral valve repair. The percutaneous transvenous mitral annuloplasty system (PTMA TM , Viacor Inc., Wilmington, USA) is an indirect annuloplasty device deployed within the coronary sinus (CS). Its mechanism is based on reduction of the anterior-posterior diameter of the mitral annulus to decrease mitral regurgitation (MR) by reestablishing leaflet coaptation in functional MR. We report the ongoing first-in-human experience with this non-stented device. 27 heart failure patients (NYHA II–IV) with functional MR II–III were enrolled at 5 centers. Via subclavian access, a multi-lumen diagnostic catheter was positioned within the anterior interventricular vein of the CS. Nitinol rods of various length and stiffness patterns were subsequently introduced into the lumina in order to exert pressure to the posterior mitral leaflet and to reduce AP diameter. Under fluoroscopic and echo guidance, different rod combinations were evaluated for maximal effectiveness before exchanging the diagnostic system to the permanent device. After assuring significant MR reduction by the permanent implant, the whole device was implanted in a subcutaneous pocket. 8 patients were excluded prior procedure due to unfavorable CS anatomy. The remaining 19 patients proceeded through a complete diagnostic exam. While the device was ineffective in 6 cases, echocardiography revealed a significant reduction of MR in 13 patients. 9 of these patients underwent successful implantation of the permanent device. 4 devices were subsequently removed, one at 7 days due to device fracture and the other 3 when the patients were referred for annuloplasty surgery due to device migration or diminished efficacy. Sustained reduction in MR and AP dimensions was noted in the remaining 4 long-term implants. No procedure related adverse events with permanent sequelae were observed in all patients. Initial human experiences with the PTMA TM device demonstrate safety and feasibility of this method as well as sustained favorable geometric modifications of the mitral annulus with reduction of MR in responding patients.

Surgical Technique: Papillary Muscle Sling for Functional Mitral Regurgitation during Minimally Invasive Valve Surgery

2013 ◽  
Vol 16 (5) ◽  
pp. E295-E297 ◽  
Author(s):  
Joseph Lamelas ◽  
Christos Mihos ◽  
Orlando Santana
Keyword(s):  
Mitral Regurgitation ◽  
Minimally Invasive ◽  
Median Sternotomy ◽  
Rational Approach ◽  
Functional Mitral Regurgitation ◽  
Minimally Invasive Approach ◽  
Invasive Approach ◽  
Mitral Annuloplasty ◽  
Technical Details ◽  
Mitral Apparatus

In patients with functional mitral regurgitation, the placement of a sling encircling both papillary muscles in conjunction with mitral annuloplasty appears to be a rational approach for surgical correction, because it addresses both the mitral valve and the deformities of the subvalvular mitral apparatus. Reports in the literature that describe the utilization of this technique are few, and mainly involve a median sternotomy approach. The purpose of this communication is to describe the technical details of performing this procedure via a minimally invasive approach.

Transcatheter reshaping of the mitral annulus in patients with functional mitral regurgitation: one-year outcomes of the MAVERIC trial

2021 ◽  
Vol 16 (13) ◽  
pp. 1106-1113
Author(s):  
Stephen Worthley ◽  
Simon Redwood ◽  
David Hildick-Smith ◽  
Tony Rafter ◽  
Alan Whelan ◽  
...  
Keyword(s):  
Mitral Regurgitation ◽  
Mitral Annulus ◽  
Functional Mitral Regurgitation ◽  
One Year

scholarly journals Ex Vivo Model of Functional Mitral Regurgitation Using Deer Hearts

2020 ◽  
Author(s):  
Michal Jaworek ◽  
Andrea Mangini ◽  
Edoardo Maroncelli ◽  
Federico Lucherini ◽  
Rubina Rosa ◽  
...  
Keyword(s):  
Mitral Regurgitation ◽  
Ex Vivo ◽  
Mitral Annulus ◽  
Left Ventricular ◽  
Functional Mitral Regurgitation ◽  
Pathological State ◽  
Preclinical Research ◽  
Ex Vivo Model ◽  
Mitral Valves ◽  
Feasibility Assessment

Abstract Transcatheter therapies are emerging for functional mitral regurgitation (FMR) treatment, however there is lack of pathological models for their preclinical assessment. We investigated the applicability of deer hearts for this purpose. 8 whole deer hearts were housed in a pulsatile flow bench. At baseline, all mitral valves featured normal coaptation. The pathological state was induced by 60-minutes intraventricular constant pressurization. It caused mitral annulus dilation (antero-posterior diameter increase from 31.8 ± 5.6 mm to 39.5 ± 4.9 mm, p = 0.001), leaflets tethering (maximal tenting height increase from 7.3 ± 2.5 mm to 12.7 ± 3.4 mm, p < 0.001) and left ventricular diameter increase (from 67.8 ± 7.5 mm to 79.4 ± 6.5 mm, p = 0.004). These geometrical reconfigurations led to restricted mitral valve leaflets motion and leaflet coaptation loss. Preliminary feasibility assessment of two FMR treatments was performed in the developed model. Deer hearts showed ability to dilate under constant pressurization and have potential to be used for realistic preclinical research of novel FMR therapies.

scholarly journals Percutaneous Mitral Annuloplasty for Functional Mitral Regurgitation

Circulation ◽  
2009 ◽  
Vol 120 (4) ◽  
pp. 326-333 ◽  
Author(s):  
Joachim Schofer ◽  
Tomasz Siminiak ◽  
Michael Haude ◽  
Jean P. Herrman ◽  
Jindra Vainer ◽  
...  
Keyword(s):  
Mitral Regurgitation ◽  
Functional Mitral Regurgitation ◽  
Mitral Annuloplasty
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