open access

Vol 71, No 12 (2013)
Original articles - new methods
Published online: 2013-12-13
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Percutaneous direct mitral annuloplasty using the Mitralign Bident™ system: description of the method and a case report

Tomasz Siminiak, Rafał Dankowski, Artur Baszko, Christopher Lee, Ludwik Firek, Piotr Kałmucki, Andrzej Szyszka, Adam Groothuis
DOI: 10.5603/KP.2013.0325
·
Kardiol Pol 2013;71(12):1287-1292.

open access

Vol 71, No 12 (2013)
Original articles - new methods
Published online: 2013-12-13

Abstract

Background: Functional mitral regurgitation (FMR) is known to contribute to a poor prognosis in patients with heart failure (HF). Current guidelines do not recommend cardiac surgery in patients with FMR and impaired ejection fraction due to thehigh procedural risk. Percutaneous techniques aimed at mitral valve repair may constitute an alternative to currently usedroutine medical treatment.

Aim: To provide a description of a novel percutaneous suture-based technique of direct mitral annuloplasty using the MitralignBident™ system, as well as report our first case successfully treated with this method.

Methods: A deflectable guiding catheter is advanced via the femoral route across the aortic valve to the posterior wall of the ventricle. A nested deflectable catheter is advanced through the guide toward the mitral annulus that allows the advancementof an insulated radiofrequency wire to cross the annulus. The wire is directed across the annulus in a target area that is 2–5 mm from the base of the leaflet into the annulus, as assessed by real-time 3D transoesophageal echocardiography. After placement of the first wire, another wire is positioned using a duel lumen bident delivery catheter, which provides a predetermined separation between wires (i.e. 14, 17 or 21 mm). Each wire provides a guide rail for implantation of sutured pledget implants within the annulus. Two pairs of pledgets are implanted, one pair in each of the P1 and P3 scallop regions ofthe posterior mitral annulus. A dedicated plication lock device is used to provide a means for plication of the annulus withineach pair of the pledgets, and to retain the plication by delivering a suture locking implant. The plications result in improvedleaflet coaptation and a reduction of the regurgitant orifice area.

Results: A 60-year-old female with diagnosed dilated cardiomyopathy, concomitant FMR class III and congestive HF was successfully treated with the Mitralign Bident™ system. Two pairs of pledgets were implanted resulting in an improvement of transoesophageal echocardiographic parameters, including proximal isovelocity surface area radius (0.7 cm to 0.4 cm), effective regurgitant orfice area (0.3 cm2 to 0.1 cm2) and mitral regurgitant volume (49 mL to 10 mL).

Conclusions: Percutaneous mitral annuloplasty with the Mitralign Bident™ system is feasible. Future clinical trials are needed to assess its safety and efficacy.

Abstract

Background: Functional mitral regurgitation (FMR) is known to contribute to a poor prognosis in patients with heart failure (HF). Current guidelines do not recommend cardiac surgery in patients with FMR and impaired ejection fraction due to thehigh procedural risk. Percutaneous techniques aimed at mitral valve repair may constitute an alternative to currently usedroutine medical treatment.

Aim: To provide a description of a novel percutaneous suture-based technique of direct mitral annuloplasty using the MitralignBident™ system, as well as report our first case successfully treated with this method.

Methods: A deflectable guiding catheter is advanced via the femoral route across the aortic valve to the posterior wall of the ventricle. A nested deflectable catheter is advanced through the guide toward the mitral annulus that allows the advancementof an insulated radiofrequency wire to cross the annulus. The wire is directed across the annulus in a target area that is 2–5 mm from the base of the leaflet into the annulus, as assessed by real-time 3D transoesophageal echocardiography. After placement of the first wire, another wire is positioned using a duel lumen bident delivery catheter, which provides a predetermined separation between wires (i.e. 14, 17 or 21 mm). Each wire provides a guide rail for implantation of sutured pledget implants within the annulus. Two pairs of pledgets are implanted, one pair in each of the P1 and P3 scallop regions ofthe posterior mitral annulus. A dedicated plication lock device is used to provide a means for plication of the annulus withineach pair of the pledgets, and to retain the plication by delivering a suture locking implant. The plications result in improvedleaflet coaptation and a reduction of the regurgitant orifice area.

Results: A 60-year-old female with diagnosed dilated cardiomyopathy, concomitant FMR class III and congestive HF was successfully treated with the Mitralign Bident™ system. Two pairs of pledgets were implanted resulting in an improvement of transoesophageal echocardiographic parameters, including proximal isovelocity surface area radius (0.7 cm to 0.4 cm), effective regurgitant orfice area (0.3 cm2 to 0.1 cm2) and mitral regurgitant volume (49 mL to 10 mL).

Conclusions: Percutaneous mitral annuloplasty with the Mitralign Bident™ system is feasible. Future clinical trials are needed to assess its safety and efficacy.

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Keywords

functional mitral regurgitation, new techniques, mitral annulus, annuloplasty

About this article
Title

Percutaneous direct mitral annuloplasty using the Mitralign Bident™ system: description of the method and a case report

Journal

Kardiologia Polska (Polish Heart Journal)

Issue

Vol 71, No 12 (2013)

Pages

1287-1292

Published online

2013-12-13

DOI

10.5603/KP.2013.0325

Bibliographic record

Kardiol Pol 2013;71(12):1287-1292.

Keywords

functional mitral regurgitation
new techniques
mitral annulus
annuloplasty

Authors

Tomasz Siminiak
Rafał Dankowski
Artur Baszko
Christopher Lee
Ludwik Firek
Piotr Kałmucki
Andrzej Szyszka
Adam Groothuis

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