| Development of an off bypass mitral valve repair. | |
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MedLine Citation:
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PMID: 11276467 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: The Bow Tie Repair (BTR), a single edge-to-edge suture opposing the anterior and posterior leaflets of the mitral valve (MV), has led to satisfactory reduction of mitral regurgitation (MR) with few re-operations and excellent hemodynamic results. The simplicity of the repair lends itself to minimally invasive approaches. A MV grasper has been developed that will coapt both leaflets and fasten the structures with a graduated spiral screw. METHODS: Eleven explanted adult human MVs were mounted in a mock circulatory loop created for simulating a variety of hemodynamic conditions. The MV grasper was used to place a screw in each valve, which was then continuously run for 300,000 to 1,000,000 cycles with a fixed transvalvular pressure gradient. At the completion of these studies, the valves were stressed to a maximal transvalvular gradient for ten minutes. In seven cases, MR was induced and subsequently repaired using the MV screw. In vivo, the MV screw was tested in nine male canines. Through a subcostal incision, the MV grasper entered the left ventricle, approximated the mitral leaflets and deployed the MV screw under direct visualization via an atriotomy. Follow-up transthoracic echocardiograms were done at postoperative week 1, 6, and 12 to identify screw migration, MV regurgitation/stenosis or clot formation. Dogs were sacrificed up to postoperative week 12 to allow gross and histologic assessment. RESULTS: In vitro, no MV screw detached from the valve leaflets or migrated during the durability testing period of 6.8 million cycles, including periods of stress load testing up to 350 mm Hg. The percent regurgitant flow used to assess MR statistically decreased with the placement of the screw from 72 +/- 7% to 34 +/- 17%; p = 0.0025. In vivo, seven dogs whose valves were examined within the first 48 hours revealed leaflet coaptation with an intact MV screw and no evidence of MR. Two dogs, followed for a prolonged period, had serial postoperative echocardiograms demonstrating consistent coaptation, no screw migration, no clot, and no regurgitation or stenosis. In the animal sacrificed at 12 weeks, the MV screw was integrated into the tissue of both leaflets. CONCLUSIONS: The MV screw has provided durable leaflet coaptation and has reduced regurgitation in human MVs. Initial data on the MV screw's biocompatibility and interactions with living valve tissue is promising. Our early success supports further efforts towards the maturation of this prototype into off bypass mitral valve repair technology. |
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Authors:
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D L Morales; J D Madigan; A F Choudhri; M R Williams; D N Helman; J B Elder; Y Naka; M C Oz |
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Publication Detail:
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Type: Evaluation Studies; Journal Article |
Journal Detail:
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Title: The heart surgery forum Volume: 2 ISSN: 1098-3511 ISO Abbreviation: Heart Surg Forum Publication Date: 1999 |
Date Detail:
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Created Date: 2001-03-29 Completed Date: 2001-08-09 Revised Date: 2007-11-15 |
Medline Journal Info:
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Nlm Unique ID: 100891112 Medline TA: Heart Surg Forum Country: United States |
Other Details:
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Languages: eng Pagination: 115-20 Citation Subset: IM |
Affiliation:
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Department of Surgery, Columbia University, College of Physicians and Surgeons, New York, NY 10032, USA. dlm@columbia.edu |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Animals Disease Models, Animal* Dogs Echocardiography, Transesophageal Equipment Design Follow-Up Studies Hemodynamics Humans Male Materials Testing Mitral Valve Insufficiency / physiopathology, surgery*, ultrasonography Mitral Valve Stenosis / physiopathology, surgery*, ultrasonography Surgical Procedures, Minimally Invasive / instrumentation*, methods Treatment Outcome |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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