A Novel Technique for Functional Mitral Regurgitation Therapy: Mitral Annular Remodeling
DOI:
https://doi.org/10.1532/HSF98.20061075Abstract
Background. Functional mitral regurgitation (AIR) plays a pivotal role in the pathophysiology of congestive heart failure, a major cause of cardiac morbidity and mortality. We have developed a mitral annular remodeling procedure through injection of a nonabsorbable substance into the peri-annular tissue of the posterior mitral annulus to reduce the mitral annular dimension in the septal-lateral axis. The purpose of this study is to describe a novel procedure for treatment of functional AIR and report its effects on the geometry of the mitral annulus and degree of AIR.
Methods. Seven preliminary studies were performed using an epicardial approach in a healthy dog model to establish the feasibility of this injection procedure. Unexpectedly, 2 of 7 healthy dogs had a functional AIR of grade 1 to 2+. In these 2 cases, the hemodynamic, angiographic, and echocar-diographic assessments were conducted.
Results. A nonabsorbable substance injection was successfully performed on a beating heart without instability of hemodynamics or any evidence of myocardial ischemia in all 7 dogs. In the 2 dogs with a functional AIR, it was confirmed that the septal-lateral dimension decreased from 3.2 ± 0.2 to 2.6 ± 0.5 cm and the observed MR was reduced (AIR area from 1.2 ±0.1 to 0 cm2) without any adverse effects on hemodynamics or coronary circulation (circumflex artery flow, 36.5 ± 0.4 to 40.5 ± 0.1 mL/min).
Conclusion. Off-pump mitral annular remodeling through substance injection may be one procedural option for treatment of functional AIR.
References
Downing SW, Herzog WA Jr, McLaughlin JS, et al. 2002. Beating-heart mitral valve surgery: preliminary model and methodology. J Thorac Cardiovasc Surg 123:1141-6.nErsek RA, Gregory SR, Salisbury AV 1997. Bioplastique at 6 years: clinical outcome studies. Plast Reconstr Surg 100:1570-4.nFeldman T, Wasserman HS, Herrmann HC, et al. 2005. Percutaneous mitral valve repair using the edge-to-edge technique. J Am Coll Cardiol 46:2134-40.nInoue M, McCarthy PM, Popovi? ZB, et al. 2004. Mitral valve repair without cardiopulmonary bypass or atriotomy using the Coapsys device: device design, and implantation procedure. Heart Surg Forum 7:E117-21.nInoue M, McCarthy PM, Popovi? ZB, et al. 2004. The Coapsys device to treat functional mitral re gurgitation: in vivo long-term canine study. J Thorac Cardiovase Surg 127:1068-77.nKaye DM, Byrne M, Alferness C, et al. 2003. Feasibility and short-term efficacy of percutaneous mitral annular reduction for the therapy of heart failure-induced mitral re gurgitation. Circulation 108:1795-7.nLiddicoat JR, Mac Neill BD, Gillinov AM, et al. 2003. Percutaneous mitral valve repair: a feasibility study in an ovine model of acute ischemic mitral regurgitation. Catheter Cardiovasc Interv 60:410-6.nRussell JD, Perry A, Cheesman AD. 1995. Cordectomy: a solution to Teflon granuloma of the vocal fold. J Laryngol Otol 109:53-5.nTimek TA, Lai DT, Liang D, et al. 2004. Effects of paracommissural septal-lateral annular cinching on acute ischemic mitral re gurgitation. Circulation 110 (suppl I): II 79-84.nTimek TA, Lai DT, Tibayan F, et al. 2002. Septal-lateral annular cinching abolishes acute ischemic mitral regurgitation. J Thorac Cardiovasc Surg 123:881-8.nYiu SF, Enriquez-Sarano M, Tribouilloy C, et al. 2000. Determinants of the degree of functional mitral regurgitation in patients with systolic left ventricular dysfunction: a quantitative clinical study. Circulation 102:1400-6.n
