Heart Valves pp 187-209 | Cite as

Transcatheter Mitral Repair and Replacement

  • Jason L. Quill
  • Ana R. Menk
  • Gilbert H. L. Tang
Chapter
First Online:

Abstract

Transcatheter mitral repair and replacement is a broad area in which many investigational devices exist. Due to the complexity of the mitral anatomy and the breadth of surgical options to treat the pathology, it is unlikely that a single transcatheter device can meet the clinical needs of this patient population. As such, transcatheter mitral devices are discussed in several groups including replacement devices, indirect annuloplasty devices, direct annuloplasty devices, edge-to-edge repair devices, chordal replacement devices, and left ventricular repair devices. Design criteria for an ideal device are discussed for each group, followed by a state-of-the-art description of the devices currently being developed.

Keywords

Mitral Valve Coronary Sinus Prosthetic Valve Mitral Annulus Left Ventricular Outflow Tract 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Abbreviations

DMR

Degenerative mitral regurgitation

E2E

Edge-to-edge

FMR

Functional mitral regurgitation

LV

Left ventricular/ventricle

LVOT

Left ventricular outflow tract

MR

Mitral regurgitation

TAVI

Transcatheter aortic valve implantation

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References

  1. 1.
    Jonsson A, Settergren M (2010) MitraClip catheter-based mitral valve repair system. Expert Rev Med Devices 7:439–447PubMedCrossRefGoogle Scholar
  2. 2.
    Martinez-Selles M, Garcia Robles JA, Prieto L et al (2002) Annual rates of admission and seasonal variations in hospitalizations for heart failure. Eur J Heart Fail 4:779–786PubMedCrossRefGoogle Scholar
  3. 3.
    Gillinov AM, Wierup PN, Blackstone EH et al (2001) Is repair preferable to replacement for ischemic mitral regurgitation? J Thorac Cardiovasc Surg 122:1125–1141PubMedCrossRefGoogle Scholar
  4. 4.
    Freed LA, Levy D, Levine RA et al (1999) Prevalence and clinical outcome of mitral-valve prolapse. N Engl J Med 341:1–7PubMedCrossRefGoogle Scholar
  5. 5.
    Monin JL, Dehant P, Roiron C et al (2005) Functional assessment of mitral regurgitation by transthoracic echocardiography using standardized imaging planes diagnostic accuracy and outcome implications. J Am Coll Cardiol 46:302–309PubMedCrossRefGoogle Scholar
  6. 6.
    Montant P, Chenot F, Robert A et al (2009) Long-term survival in asymptomatic patients with severe degenerative mitral regurgitation: a propensity score-based comparison between an early surgical strategy and a conservative treatment approach. J Thorac Cardiovasc Surg 138:1339–1348PubMedCrossRefGoogle Scholar
  7. 7.
    Zahn R, Gerckens U, Grube E et al (2011) Transcatheter aortic valve implantation: first results from a multi-centre real-world registry. Eur Heart J 32:198–204PubMedCrossRefGoogle Scholar
  8. 8.
    Leon MB, Smith CR, Mack M et al (2010) Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery. N Engl J Med 363:1597–1607PubMedCrossRefGoogle Scholar
  9. 9.
    Feldman T, Kar S, Rinaldi M et al (2009) Percutaneous mitral repair with the MitraClip system: safety and midterm durability in the initial EVEREST (Endovascular Valve Edge-to-Edge REpair Study) cohort. J Am Coll Cardiol 54:686–694PubMedCrossRefGoogle Scholar
  10. 10.
    Feldman T, Wasserman HS, Herrmann HC et al (2005) Percutaneous mitral valve repair using the edge-to-edge technique: six-month results of the EVEREST Phase I Clinical Trial. J Am Coll Cardiol 46:2134–2140PubMedCrossRefGoogle Scholar
  11. 11.
    Tamburino C, Ussia GP, Maisano F et al (2010) Percutaneous mitral valve repair with the MitraClip system: acute results from a real world setting. Eur Heart J 31:1382–1389PubMedCrossRefGoogle Scholar
  12. 12.
    Walther T, Schuler G, Borger MA et al (2010) Transapical aortic valve implantation in 100 consecutive patients: comparison to propensity-matched conventional aortic valve replacement. Eur Heart J 31:1398–1403PubMedCrossRefGoogle Scholar
  13. 13.
    Bleiziffer S, Ruge H, Mazzitelli D et al (2009) Survival after transapical and transfemoral aortic valve implantation: talking about two different patient populations. J Thorac Cardiovasc Surg 138:1073–1080PubMedCrossRefGoogle Scholar
  14. 14.
    Bruschi G, De Marco F, Fratto P et al (2010) Direct aortic access through right minithoracotomy for implantation of self-expanding aortic bioprosthetic valves. J Thorac Cardiovasc Surg 140:715–717PubMedCrossRefGoogle Scholar
  15. 15.
    Lozonschi L, Bombien R, Osaki S et al (2010) Transapical mitral valved stent implantation: a survival series in swine. J Thorac Cardiovasc Surg 140(422–426):e421Google Scholar
  16. 16.
    Wendling P (2011) PARTNER puts TAVR in reach of older, high-risk patients. MedConnect Cardiology, Elsevier Global Medical News, 4 April 2011Google Scholar
  17. 17.
    Falk V, Walther T, Schwammenthal E et al (2011) Transapical aortic valve implantation with a self-expanding anatomically oriented valve. Eur Heart J 32:878–887PubMedCrossRefGoogle Scholar
  18. 18.
    Mack M (2011) Progress with transcatheter mitral valve replacement I: CardiAQ. Paper presented at transcatheter valve technologies, Vancouver, Canada, 6 June 2011Google Scholar
  19. 19.
    Krishnaswamy A, Tuzcu EM, Kapadia SR (2010) Update on transcatheter aortic valve implantation. Curr Cardiol Rep 12:393–403PubMedCrossRefGoogle Scholar
  20. 20.
    De Canniere D, Jansens JL, Unger P et al (1997) Left ventricular outflow tract obstruction after mitral valve replacement. Ann Thorac Surg 64:1805–1806PubMedCrossRefGoogle Scholar
  21. 21.
    Okamoto K, Kiso I, Inoue Y et al (2006) Left ventricular outflow obstruction after mitral valve replacement preserving native anterior leaflet. Ann Thorac Surg 82:735–737PubMedCrossRefGoogle Scholar
  22. 22.
    Said SM, Schaff HV, Suri RM et al (2011) Bulging subaortic septum: an important risk factor for systolic anterior motion after mitral valve repair. Ann Thorac Surg 91:1427–1432PubMedCrossRefGoogle Scholar
  23. 23.
    Gams E, Schad H, Heimisch W et al (1990) Preservation versus severance of the subvalvular apparatus in mitral valve replacement: an experimental study. Eur J Cardiothorac Surg 4:250–255; discussion 255–256Google Scholar
  24. 24.
    Natsuaki M, Itoh T, Tomita S et al (1996) Importance of preserving the mitral subvalvular apparatus in mitral valve replacement. Ann Thorac Surg 61:585–590PubMedCrossRefGoogle Scholar
  25. 25.
    Tsuneyoshi H, Komeda M (2005) Update on mitral valve surgery. J Artif Organs 8:222–227PubMedCrossRefGoogle Scholar
  26. 26.
    Faludi R, Szulik M, D’Hooge J et al (2010) Left ventricular flow patterns in healthy subjects and patients with prosthetic mitral valves: an in vivo study using echocardiographic particle image velocimetry. J Thorac Cardiovasc Surg 139:1501–1510PubMedCrossRefGoogle Scholar
  27. 27.
    Webb JG, Wood DA, Ye J et al (2010) Transcatheter valve-in-valve implantation for failed bioprosthetic heart valves. Circulation 121:1848–1857PubMedCrossRefGoogle Scholar
  28. 28.
    Kempfert J, Blumenstein J, Chu MW et al (2009) Minimally invasive off-pump valve-in-a-ring implantation: the atrial transcatheter approach for re-operative mitral valve replacement after failed repair. Eur J Cardiothorac Surg 35:965–969; discussion 969Google Scholar
  29. 29.
    Kempfert J, Blumenstein JM, Borger MA et al (2008) Minimally invasive off-pump valve-in-a-valve implantation: the atrial transcatheter approach for re-operative mitral valve replacement. Eur Heart J 29:2382–2387PubMedCrossRefGoogle Scholar
  30. 30.
    Boudjemline Y, Pineau E, Borenstein N et al (2005) New insights in minimally invasive valve replacement: description of a cooperative approach for the off-pump replacement of mitral valves. Eur Heart J 26:2013–2017PubMedCrossRefGoogle Scholar
  31. 31.
    Siminiak T, Hoppe UC, Schofer J et al (2009) Effectiveness and safety of percutaneous coronary sinus-based mitral valve repair in patients with dilated cardiomyopathy (from the AMADEUS trial). Am J Cardiol 104:565–570PubMedCrossRefGoogle Scholar
  32. 32.
    Dubreuil O, Basmadjian A, Ducharme A et al (2007) Percutaneous mitral valve annuloplasty for ischemic mitral regurgitation: first in man experience with a temporary implant. Catheter Cardiovasc Interv 69:1053–1061PubMedCrossRefGoogle Scholar
  33. 33.
    Sack S, Kahlert P, Bilodeau L et al (2009) Percutaneous transvenous mitral annuloplasty: initial human experience with a novel coronary sinus implant device. Circ Cardiovasc Interv 2:277–284PubMedCrossRefGoogle Scholar
  34. 34.
    Maselli D, Guarracino F, Chiaramonti F et al (2006) Percutaneous mitral annuloplasty: an anatomic study of human coronary sinus and its relation with mitral valve annulus and coronary arteries. Circulation 114:377–380PubMedCrossRefGoogle Scholar
  35. 35.
    Tops LF, Van de Veire NR, Schuijf JD et al (2007) Noninvasive evaluation of coronary sinus anatomy and its relation to the mitral valve annulus: implications for percutaneous mitral annuloplasty. Circulation 115:1426–1432PubMedCrossRefGoogle Scholar
  36. 36.
    Plass A, Valenta I, Gaemperli O, Kaufmann P et al (2008) Assessment of coronary sinus anatomy between normal and insufficient mitral valves by multi-slice computertomography for mitral annuloplasty device implantation. Eur J Cardiothorac Surg 33:583–589PubMedCrossRefGoogle Scholar
  37. 37.
    Mao S, Shinbane JS, Girsky MJ et al (2005) Coronary venous imaging with electron beam computed tomographic angiography: three-dimensional mapping and relationship with coronary arteries. Am Heart J 150:315–322PubMedCrossRefGoogle Scholar
  38. 38.
    Feldman T, Cilingiroglu M (2011) Percutaneous leaflet repair and annuloplasty for mitral regurgitation. J Am Coll Cardiol 57:529–537PubMedCrossRefGoogle Scholar
  39. 39.
    Wu AH, Aaronson KD, Bolling SF et al (2005) Impact of mitral valve annuloplasty on mortality risk in patients with mitral regurgitation and left ventricular systolic dysfunction. J Am Coll Cardiol 45:381–387PubMedCrossRefGoogle Scholar
  40. 40.
    Mihaljevic T, Lam BK, Rajeswaran J et al (2007) Impact of mitral valve annuloplasty combined with revascularization in patients with functional ischemic mitral regurgitation. J Am Coll Cardiol 49:2191–2201PubMedCrossRefGoogle Scholar
  41. 41.
    McCarthy PM, Bhudia SK, Rajeswaran J et al (2004) Tricuspid valve repair: durability and risk factors for failure. J Thorac Cardiovasc Surg 127:674–685PubMedCrossRefGoogle Scholar
  42. 42.
    Matsuyama K, Matsumoto M, Sugita T et al (2001) De Vega annuloplasty and Carpentier-Edwards ring annuloplasty for secondary tricuspid regurgitation. J Heart Valve Dis 10:520–524PubMedGoogle Scholar
  43. 43.
    Rivera R, Duran E, Ajuria M (1985) Carpentier’s flexible ring versus De Vega’s annuloplasty. A prospective randomized study. J Thorac Cardiovasc Surg 89:196–203PubMedGoogle Scholar
  44. 44.
    Yada I, Tani K, Shimono T et al (1990) [Preoperative diagnosis and surgical treatment of tricuspid regurgitation (TR) in patients with acquired valvular heart disease—comparison of Kay’s annuloplasty and Carpentier’s ring annuloplasty for tricuspid valve surgery]. Nippon Kyobu Geka Gakkai Zasshi 38:421–428PubMedGoogle Scholar
  45. 45.
    Holper K, Haehnel JC, Augustin N et al (1993) Surgery for tricuspid insufficiency: long-term follow-up after De Vega annuloplasty. Thorac Cardiovasc Surg 41:1–8PubMedCrossRefGoogle Scholar
  46. 46.
    Bernal JM, Gutierrez-Morlote J, Llorca J et al (2004) Tricuspid valve repair: an old disease, a modern experience. Ann Thorac Surg 78:2069–2074; discussion 2074–2075Google Scholar
  47. 47.
    Ghanta RK, Chen R, Narayanasamy N et al (2007) Suture bicuspidization of the tricuspid valve versus ring annuloplasty for repair of functional tricuspid regurgitation: midterm results of 237 consecutive patients. J Thorac Cardiovasc Surg 133:117–126PubMedCrossRefGoogle Scholar
  48. 48.
    Tibayan FA, Rodriguez F, Langer F et al (2004) Does septal-lateral annular cinching work for chronic ischemic mitral regurgitation? J Thorac Cardiovasc Surg 127:654–663PubMedCrossRefGoogle Scholar
  49. 49.
    Chiam PT, Ruiz CE (2011) Percutaneous transcatheter mitral valve repair: a classification of the technology. JACC Cardiovasc Interv 4:1–13PubMedCrossRefGoogle Scholar
  50. 50.
    Nakanishi K, Raman J, Hata M et al (2001) [Early outcome with the Alfieri mitral valve repair]. J Cardiol 37:263–266PubMedGoogle Scholar
  51. 51.
    Alfieri O, Maisano F, De Bonis M et al (2001) The double-orifice technique in mitral valve repair: a simple solution for complex problems. J Thorac Cardiovasc Surg 122:674–681PubMedCrossRefGoogle Scholar
  52. 52.
    Alfieri O, Maisano F (1999) An effective technique to correct anterior mitral leaflet prolapse. J Card Surg 14:468–470PubMedCrossRefGoogle Scholar
  53. 53.
    Alfieri OM, Maisano F, De Bonis, M (2005) The edge-to-edge repair. MMCTS 2005. doi:10.1510/mmcts.2004.000869Google Scholar
  54. 54.
    Bhudia SK, McCarthy PM, Smedira NG et al (2004) Edge-to-edge (Alfieri) mitral repair: results in diverse clinical settings. Ann Thorac Surg 77:1598–1606PubMedCrossRefGoogle Scholar
  55. 55.
    David TE, Bos J, Rakowski H (1991) Mitral valve repair by replacement of chordae tendineae with polytetrafluoroethylene sutures. J Thorac Cardiovasc Surg 101:495–501PubMedGoogle Scholar
  56. 56.
    Seeburger J, Falk V, Borger MA et al (2009) Chordae replacement versus resection for repair of isolated posterior mitral leaflet prolapse: a egalite. Ann Thorac Surg 87:1715–1720PubMedCrossRefGoogle Scholar
  57. 57.
    Seeburger J, Borger MA, Tschernich H et al (2010) Transapical beating heart mitral valve repair. Circ Cardiovasc Interv 3:611–612PubMedCrossRefGoogle Scholar
  58. 58.
    Tibayan FA, Rodriguez F, Langer F et al (2005) Annular or subvalvular approach to chronic ischemic mitral regurgitation? J Thorac Cardiovasc Surg 129:1266–1275PubMedCrossRefGoogle Scholar
  59. 59.
    Tibayan FA, Rodriguez F, Zasio MK et al (2003) Geometric distortions of the mitral valvular-­ventricular complex in chronic ischemic mitral regurgitation. Circulation 108(suppl 1):II116–II121PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Jason L. Quill
    • 1
  • Ana R. Menk
    • 1
  • Gilbert H. L. Tang
    • 2
  1. 1.Medtronic, Inc.Mounds ViewUSA
  2. 2.Mount Sinai Medical CenterNew YorkUSA

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