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Everett KD, Kapur NK. Devices for ventricular reconstruction in heart failure due to infarct cardiomyopathy. J Card Fail 2022; 28:614-616. [PMID: 35038596 DOI: 10.1016/j.cardfail.2022.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 01/06/2022] [Indexed: 10/19/2022]
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Left Ventricular Thinning and Distension in Pig Hearts as a Reproducible Ex Vivo Model of Functional Mitral Regurgitation. ASAIO J 2021; 66:1016-1024. [PMID: 32870609 DOI: 10.1097/mat.0000000000001145] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Functional mitral regurgitation in the setting of an enlarged heart is challenging to repair surgically with an annular approach, and the need to develop subannular and ventricular approaches is recognized yet unrealized because of the lack of models for investigations. In this study, we report a novel model of functional mitral regurgitation induced by left ventricular thinning and distension in pig hearts. Seven pig hearts were explanted at a local slaughterhouse, and left ventricular distension induced by thinning the ventricular myocardium by 60-65% of its original thickness. Distension of the thinned hearts with a 120 mmHg column confirmed significant left ventricular dilatation and mitral valve tethering. These hearts were then mounted into a pulsatile flow model and animated at 120 mmHg left ventricular pressure, 5 L/min cardiac output at 70 beats/min. Echocardiography was used to assess valvular kinematics and hemodynamics. Left ventricular wall thickness reduced by 60.5% ± 10.1% at the basal plane, 64.8% ± 11.3% at the equatorial plane, and 64.0% ± 11.4% at the apical plane after thinning. Upon distension, ventricular volumes increased by 852.4% ± 639.8% after left ventricular thinning, with an 89.5% ± 33.9% increase in sphericity index. Mitral valve systolic tenting height increased from 7.92 ± 2.06 to 15.02 ± 3.89 mm, systolic tethering area increased from 130.7 ± 38.2 to 409.9 ± 124.6 mm and an average mitral regurgitation fraction of 24.4% ± 16.6% was measured. In a case study, use of multimodality imaging to test the efficacy of transcatheter mitral devices was confirmed. Ventricular wall thinning leading to passive left ventricular distension and dilatation is a reproducible ex vivo model of mitral valve tethering and functional mitral regurgitation, which in combination with multimodality imaging provides a good simulation model.
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Treatment options for ischemic mitral regurgitation: A meta-analysis. J Thorac Cardiovasc Surg 2020; 163:607-622.e14. [PMID: 32713629 DOI: 10.1016/j.jtcvs.2020.05.041] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 05/12/2020] [Accepted: 05/15/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND Treatment of ischemic mitral regurgitation (IMR) is in evolution, as percutaneous procedures and complex surgical repair have been recently investigated in randomized clinical trials and matched studies. This study aims to review and compare the current treatment options for IMR. METHODS A comprehensive literature search was conducted using electronic databases. The primary outcome was all-cause long-term mortality. The secondary outcomes were perioperative mortality, unplanned rehospitalization, reoperation, and composite end points as defined in the original articles. RESULTS A total of 12 articles met the inclusion criteria and were included in the final meta-analysis. The MitraClip procedure did not confer a significant benefit in mortality and repeated hospitalization compared with medical therapy alone. In patients with moderate IMR, the adjunct of mitral procedure over coronary artery bypass graft is not associated with clinical improvements. When evaluating mitral valve (MV) replacement versus repair, hospital mortality was greater among patients undergoing replacement (odds ratio [OR], 1.91; P = .009), but both reoperation and readmission rates were lower (OR, 0.60, P = .05; and OR, 0.45, P < .02, respectively). Comparing restrictive annuloplasty alone with adjunctive subvalvular repair, subvalvular procedures resulted in fewer readmissions (OR, 0.50; P = .06) and adverse composite end points (P = .009). CONCLUSIONS MitraClip procedure is not associated with improved outcomes compared with medical therapy. MV replacement is associated with increased early mortality but reduced reoperation rate and readmission rate compared with MV repair using annuloplasty in moderate-to-severe IMR. Despite no significant benefit in isolated outcomes comparing annular and adjunct subvalvular procedures, the adjunct of subvalvular procedures reduces the risk of major postoperative adverse events.
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Park YH, Chon MK, Lederman RJ, Sung SC, Je HG, Choo KS, Lee SH, Shin ES, Kim JS, Hwang KW, Lee SY, Chun KJ, Kim CM, Kim JH. Mitral Loop Cerclage Annuloplasty for Secondary Mitral Regurgitation: First Human Results. JACC Cardiovasc Interv 2017; 10:597-610. [PMID: 28335897 DOI: 10.1016/j.jcin.2016.12.282] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 12/24/2016] [Accepted: 12/29/2016] [Indexed: 02/03/2023]
Abstract
OBJECTIVES This is an early feasibility clinical test of mitral loop cerclage annuloplasty to treat secondary mitral valve regurgitation. BACKGROUND Secondary mitral regurgitation is characterized by cardiomyopathy, mitral annular enlargement, and leaflet traction contributing to malcoaptation. Transcatheter mitral loop cerclage applies circumferential compression to the mitral annulus by creating a loop through the coronary sinus across the interventricular septum, protecting entrapped coronary arteries from compression, and interactive annular reduction under echocardiographic guidance. This is the first human test of mitral loop annuloplasty. METHODS Five subjects with severe symptomatic secondary mitral regurgitation underwent mitral loop cerclage, with echocardiographic and computed tomography follow-up over 6 months. RESULTS Mitral loop cerclage was successful in 4 of 5 subjects and aborted in 1 of the 5 because of unsuitable septal coronary vein anatomy. Immediately and over 6 months, measures of both mitral valve regurgitation (effective orifice area and regurgitation fraction) and chamber dimensions (left atrial and left ventricular volumes) were reduced progressively and ejection fractions increased. Two with persistent and permanent atrial fibrillation spontaneously reverted to sinus rhythm during follow-up. One subject experienced a small myocardial infarction from an unrecognized small branch coronary occlusion. Another, experiencing cardiogenic shock at baseline, died of intractable heart failure after 6 weeks. CONCLUSIONS In this first human test, mitral loop cerclage annuloplasty was successful in 4 of 5 attempts, caused reverse remodeling (reduction in secondary mitral regurgitation and heart chamber volumes), and suggested electrical remodeling (reversion of atrial fibrillation). Further evaluation is warranted.
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Affiliation(s)
- Yong-Hyun Park
- Cardiovascular Center, Pusan National University Yangsan Hospital, Yangsan & Pusan National University, Yangsan, Korea
| | - Min-Ku Chon
- Cardiovascular Center, Pusan National University Yangsan Hospital, Yangsan & Pusan National University, Yangsan, Korea
| | - Robert J Lederman
- Cardiovascular and pulmonary branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Si-Chan Sung
- Cardiovascular Center, Pusan National University Yangsan Hospital, Yangsan & Pusan National University, Yangsan, Korea
| | - Hyung-Gon Je
- Cardiovascular Center, Pusan National University Yangsan Hospital, Yangsan & Pusan National University, Yangsan, Korea
| | - Ki-Seok Choo
- Cardiovascular Center, Pusan National University Yangsan Hospital, Yangsan & Pusan National University, Yangsan, Korea
| | - Sang-Hyun Lee
- Cardiovascular Center, Pusan National University Yangsan Hospital, Yangsan & Pusan National University, Yangsan, Korea
| | - Eun-Seok Shin
- Division of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Jeong-Su Kim
- Cardiovascular Center, Pusan National University Yangsan Hospital, Yangsan & Pusan National University, Yangsan, Korea
| | - Ki-Won Hwang
- Cardiovascular Center, Pusan National University Yangsan Hospital, Yangsan & Pusan National University, Yangsan, Korea
| | - Soo-Yong Lee
- Cardiovascular Center, Pusan National University Yangsan Hospital, Yangsan & Pusan National University, Yangsan, Korea
| | - Kook-Jin Chun
- Cardiovascular Center, Pusan National University Yangsan Hospital, Yangsan & Pusan National University, Yangsan, Korea
| | - Cheol-Min Kim
- Research Center for Anti-Aging Technology Development, Pusan National University, Pusan, Korea
| | - June-Hong Kim
- Cardiovascular Center, Pusan National University Yangsan Hospital, Yangsan & Pusan National University, Yangsan, Korea.
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Shamoun FE, Craner RC, Seggern RV, Makar G, Ramakrishna H. Percutaneous and minimally invasive approaches to mitral valve repair for severe mitral regurgitation-new devices and emerging outcomes. Ann Card Anaesth 2016; 18:528-36. [PMID: 26440239 PMCID: PMC4881663 DOI: 10.4103/0971-9784.166462] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Mitral valve disease is common in the United States and around the world, and if left untreated, increases cardiovascular morbidity and mortality. Mitral valve repair is technically more demanding than mitral valve replacement. Mitral valve repair should be considered the first line of treatment for mitral regurgitation in younger patients, mitral valve prolapse, annular dilatation, and with structural damage to the valve. Several minimally invasive percutaneous treatment options for mitral valve repair are available that are not restricted to conventional surgical approaches, and may be better received by patients. A useful classification system of these approaches proposed by Chiam and Ruiz is based on anatomic targets and device action upon the leaflets, annulus, chordae, and left ventricle. Future directions of minimally invasive techniques will include improving the safety profile through patient selection and risk stratification, improvement of current imaging and techniques, and multidisciplinary education.
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Espiritu D, Onohara D, Kalra K, Sarin EL, Padala M. Transcatheter Mitral Valve Repair Therapies: Evolution, Status and Challenges. Ann Biomed Eng 2016; 45:332-359. [DOI: 10.1007/s10439-016-1655-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 05/14/2016] [Indexed: 12/21/2022]
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Morgan AE, Pantoja JL, Weinsaft J, Grossi E, Guccione JM, Ge L, Ratcliffe M. Finite Element Modeling of Mitral Valve Repair. J Biomech Eng 2016; 138:021009. [PMID: 26632260 PMCID: PMC5101040 DOI: 10.1115/1.4032125] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2015] [Revised: 11/18/2015] [Indexed: 11/08/2022]
Abstract
The mitral valve is a complex structure regulating forward flow of blood between the left atrium and left ventricle (LV). Multiple disease processes can affect its proper function, and when these diseases cause severe mitral regurgitation (MR), optimal treatment is repair of the native valve. The mitral valve (MV) is a dynamic structure with multiple components that have complex interactions. Computational modeling through finite element (FE) analysis is a valuable tool to delineate the biomechanical properties of the mitral valve and understand its diseases and their repairs. In this review, we present an overview of relevant mitral valve diseases, and describe the evolution of FE models of surgical valve repair techniques.
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Affiliation(s)
- Ashley E. Morgan
- University of California,
San Francisco—East Bay Surgical Residency,
Oakland, CA 94602
e-mail:
| | - Joe Luis Pantoja
- School of Medicine,
University of California, San Francisco,
San Francisco, CA 94143
e-mail:
| | - Jonathan Weinsaft
- Department of Cardiology,
Cornell University School of Medicine,
New York, NY 10065
e-mail:
| | - Eugene Grossi
- Department of Cardiothoracic Surgery,
NYU School of Medicine,
New York, NY 10016
e-mail:
| | - Julius M. Guccione
- Department of Surgery and Bioengineering,
University of California, San Francisco,
San Francisco, CA 94143
e-mail:
| | - Liang Ge
- Department of Surgery and Bioengineering,
Veterans Affairs Medical Center,
University of California, San Francisco,
San Francisco, CA 94121
e-mail:
| | - Mark Ratcliffe
- Surgical Service (112)
Departments of Surgery and Bioengineering,
Veterans Affairs Medical Center,
University of California, San Francisco,
4150 Clement Street,
San Francisco, CA 94121
e-mail:
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A novel coaptation plate device for functional mitral regurgitation: an in vitro study. Ann Biomed Eng 2015; 42:2039-47. [PMID: 25015132 DOI: 10.1007/s10439-014-1065-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Accepted: 06/30/2014] [Indexed: 10/25/2022]
Abstract
A novel mitral valve repair device, coaptation plate (CP), was proposed to treat functional mitral regurgitation. The objective of this study was to test efficacy of the CP in an in vitro model of functional mitral regurgitation. Ten fresh porcine mitral valves were mounted in a left heart simulator, Mitral regurgitation was emulated by means of annular dilatation, and the asymmetrical or symmetrical papillary muscles (PM) displacement. A rigid and an elastic CPs were fabricated and mounted in the orifice of regurgitant mitral valves. Steady flow leakage in a hydrostatic condition and regurgitant volume in a pulsatile flow were measured before and after implantation of the CPs. The rigid and elastic CPs reduced mitral valve regurgitant volume fraction from 60.5 ± 11.4 to 35 ± 11.6 and 36.5 ± 9.9%, respectively, in the asymmetric PM displacement. Mitral regurgitation was much lower in the symmetric PM displacement than in the asymmetric PM displacement, and was not significantly reduced after implantation of either CP. In conclusion, both the rigid and elastic CPs are effective and have no difference in reduction of functional mitral regurgitation. The CP does not aggravate mitral valve coaptation and may be used as a preventive way.
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Abstract
Mitral regurgitation (MR) is a common, progressive, and difficult-to-manage disease. MR is dynamic in nature, with physiological fluctuations occurring in response to various stimuli such as exercise and ischaemia, which can precipitate the development of symptoms and subsequent cardiac events. In both chronic primary and secondary MR, the dynamic behaviour of MR can be reliably examined during stress echocardiography. Dynamic fluctuation of MR can also have prognostic value; patients with a marked increase in regurgitant volume or who exhibit increased systolic pulmonary artery pressure during exercise have lower symptom-free survival than those who do not experience significant changes in MR and systolic pulmonary artery pressure during exercise. Identifying patients who have dynamic MR, and understanding the mechanisms underlying the condition, can potentially influence revascularization strategies (such as the surgical restoration of coronary blood flow) and interventional treatment (including cardiac resynchronization therapy and new approaches targeted to the mitral valve).
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10
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Revuelta JM. La reparación de la insuficiencia mitral entre 2 orillas. CIRUGIA CARDIOVASCULAR 2015. [DOI: 10.1016/j.circv.2015.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Pantoja JL, Ge L, Zhang Z, Morrel WG, Guccione JM, Grossi EA, Ratcliffe MB. Posterior papillary muscle anchoring affects remote myofiber stress and pump function: finite element analysis. Ann Thorac Surg 2014; 98:1355-62. [PMID: 25130075 PMCID: PMC6051352 DOI: 10.1016/j.athoracsur.2014.04.077] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2014] [Revised: 04/14/2014] [Accepted: 04/15/2014] [Indexed: 11/17/2022]
Abstract
BACKGROUND The role of posterior papillary muscle anchoring (PPMA) in the management of chronic ischemic mitral regurgitation (CIMR) is controversial. We studied the effect of anchoring point direction and relocation displacement on left ventricular (LV) regional myofiber stress and pump function. METHODS Previously described finite element models of sheep 16 weeks after posterolateral myocardial infarction (MI) were used. True-sized mitral annuloplasty (MA) ring insertion plus different PPM anchoring techniques were simulated. Anchoring points tested included both commissures and the central anterior mitral annulus; relocation displacement varied from 10% to 40% of baseline diastolic distance from the PPM to the anchor points on the annulus. For each reconstruction scenario, myofiber stress in the MI, border zone, and remote myocardium as well as pump function were calculated. RESULTS PPMA caused reductions in myofiber stress at end-diastole and end-systole in all regions of the left ventricle that were proportional to the relocation displacement. Although stress reduction was greatest in the MI region, it also occurred in the remote region. The maximum 40% displacement caused a slight reduction in LV pump function. However, with the correction of regurgitation by MA plus PPMA, there was an overall increase in forward stroke volume. Finally, anchoring point direction had no effect on myofiber stress or pump function. CONCLUSIONS PPMA reduces remote myofiber stress, which is proportional to the absolute distance of relocation and independent of anchoring point. Aggressive use of PPMA techniques to reduce remote myofiber stress may accelerate reverse LV remodeling without impairing LV function.
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Affiliation(s)
- Joe Luis Pantoja
- School of Medicine, University of California, San Francisco, San Francisco, California
| | - Liang Ge
- Department of Surgery, University of California, San Francisco, San Francisco, California; Department of Bioengineering, University of California, San Francisco, San Francisco, California; Veterans Affairs Medical Center, San Francisco, California
| | - Zhihong Zhang
- Veterans Affairs Medical Center, San Francisco, California
| | - William G Morrel
- School of Medicine, University of California, San Francisco, San Francisco, California
| | - Julius M Guccione
- Department of Surgery, University of California, San Francisco, San Francisco, California; Department of Bioengineering, University of California, San Francisco, San Francisco, California; Veterans Affairs Medical Center, San Francisco, California
| | - Eugene A Grossi
- Department of Cardiothoracic Surgery, New York University, New York, New York; New York Harbor Veterans Affairs Medical Center, New York, New York
| | - Mark B Ratcliffe
- Department of Surgery, University of California, San Francisco, San Francisco, California; Department of Bioengineering, University of California, San Francisco, San Francisco, California; Veterans Affairs Medical Center, San Francisco, California.
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Abstract
Nonsurgical treatment of clinically important mitral regurgitation (MR) has evolved tremendously over the past decade. Recent studies of percutaneous mitral valve repair procedures have shown that less invasive procedures are safe and can be effective in selected patients. MitraClip has been studied most extensively. The MitraClip is attached to the middle scallop of the mitral leaflets by a transseptal-transvascular approach. The device approximates the leaflets in an edge-to-edge percutaneous repair technique that diminishes MR, improves functional status, and improves left ventricular remodeling. The subgroup that has the most benefit includes patients with older age, poorer left ventricular function, and functional MR and is considered high risk for surgical valve replacement. Other novel percutaneous mitral valve therapies under investigation include indirect and direct annuloplasty, and ventricular remodeling devices.
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Affiliation(s)
- Amelia Young
- Cardiology Division-Walgreen Building 3rd Floor, Evanston Hospital, 2650 Ridge Ave., Evanston, IL, 60201, USA
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Feldman T, Young A. Percutaneous Approaches to Valve Repair for Mitral Regurgitation. J Am Coll Cardiol 2014; 63:2057-2068. [DOI: 10.1016/j.jacc.2014.01.039] [Citation(s) in RCA: 104] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Revised: 01/17/2014] [Accepted: 01/28/2014] [Indexed: 11/16/2022]
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Diastolic ventricular support with cardiac support devices: an alternative approach to prevent adverse ventricular remodeling. Heart Fail Rev 2013; 18:55-63. [PMID: 22527015 DOI: 10.1007/s10741-012-9312-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Heart failure is a global epidemic with limited therapy. Abnormal left ventricular wall stress in the diseased myocardium results in a biochemical positive feedback loop that results in global ventricular remodeling and further deterioration of myocardial function. Mechanical myocardial restraints such as the Acorn CorCap and Paracor HeartNet ventricular restraints have attempted to minimize diastolic ventricular wall stress and limit adverse ventricular remodeling. Unfortunately, these therapies have not yielded viable clinical therapies for heart failure. Cellular and novel biopolymer-based therapies aimed at stabilizing pathologic myocardium hold promise for translation to clinical therapy in the future.
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Tang D, Yang C, Geva T, Rathod R, Yamauchi H, Gooty V, Tang A, Kural MH, Billiar KL, Gaudette G, del Nido PJ. A Multiphysics Modeling Approach to Develop Right Ventricle Pulmonary Valve Replacement Surgical Procedures with a Contracting Band to Improve Ventricle Ejection Fraction. COMPUTERS & STRUCTURES 2013; 122:78-87. [PMID: 23667272 PMCID: PMC3649854 DOI: 10.1016/j.compstruc.2012.11.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Patients with repaired tetralogy of Fallot account for the majority of cases with late onset right ventricle (RV) failure. A new surgical procedure placing an elastic band in the right ventricle is proposed to improve RV function measured by ejection fraction. A multiphysics modeling approach is developed to combine cardiac magnetic resonance imaging, modeling, tissue engineering and mechanical testing to demonstrate feasibility of the new surgical procedure. Our modeling results indicated that the new surgical procedure has the potential to improve right ventricle ejection fraction by 2-7% which compared favorably with recently published drug trials to treat LV heart failure.
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Affiliation(s)
- Dalin Tang
- Mathematical Sciences Department, Worcester Polytechnic Institute, Worcester, MA 01609
| | - Chun Yang
- Mathematical Sciences Department, Worcester Polytechnic Institute, Worcester, MA 01609
- School of Mathematical Sciences, Beijing Normal University, Key Laboratory of Mathematics and Complex Systems, Ministry of Education, Beijing, 100875, China
| | - Tal Geva
- Dept of Cardiology, Children’s Hospital Boston, Dept of Pediatrics, Harvard Medical School, Boston, MA 02115 USA
| | - Rahul Rathod
- Dept of Cardiology, Children’s Hospital Boston, Dept of Pediatrics, Harvard Medical School, Boston, MA 02115 USA
| | - Haruo Yamauchi
- Dept. of Cardiac Surgery, Children’s Hospital Boston, Dept of Surgery, Harvard Medical School, Boston, MA 02115 USA
| | - Vasu Gooty
- Dept of Cardiology, Children’s Hospital Boston, Dept of Pediatrics, Harvard Medical School, Boston, MA 02115 USA
| | - Alexander Tang
- Dept of Cardiology, Children’s Hospital Boston, Dept of Pediatrics, Harvard Medical School, Boston, MA 02115 USA
| | - Mehmet H. Kural
- Dept of Biomedical Engineering, Worcester Polytechnic Institute, MA 01609, USA
| | - Kristen L. Billiar
- Dept of Biomedical Engineering, Worcester Polytechnic Institute, MA 01609, USA
- Department of Surgery, University of Massachusetts Medical School, Worcester, MA 01655
| | - Glenn Gaudette
- Dept of Biomedical Engineering, Worcester Polytechnic Institute, MA 01609, USA
| | - Pedro J. del Nido
- Dept. of Cardiac Surgery, Children’s Hospital Boston, Dept of Surgery, Harvard Medical School, Boston, MA 02115 USA
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Functional mitral regurgitation: a 30-year unresolved surgical journey from valve replacement to complex valve repairs. Heart Fail Rev 2013; 19:341-58. [DOI: 10.1007/s10741-013-9392-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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17
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Carrick R, Ge L, Lee LC, Zhang Z, Mishra R, Axel L, Guccione JM, Grossi EA, Ratcliffe MB. Patient-specific finite element-based analysis of ventricular myofiber stress after Coapsys: importance of residual stress. Ann Thorac Surg 2012; 93:1964-71. [PMID: 22560323 DOI: 10.1016/j.athoracsur.2012.03.001] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2011] [Revised: 02/28/2012] [Accepted: 03/01/2012] [Indexed: 12/19/2022]
Abstract
BACKGROUND We sought to determine regional myofiber stress after Coapsys device (Myocor, Inc, Maple Grove, MN) implantation using a finite element model of the left ventricle (LV). Chronic ischemic mitral regurgitation is caused by LV remodeling after posterolateral myocardial infarction. The Coapsys device consists of a single trans-LV chord placed below the mitral valve such that when tensioned it alters LV shape and decreases chronic ischemic mitral regurgitation. METHODS Finite element models of the LV were based on magnetic resonance images obtained before (preoperatively) and after (postoperatively) coronary artery bypass grafting with Coapsys implantation in a single patient. To determine the effect of Coapsys and LV before stress, virtual Coapsys was performed on the preoperative model. Diastolic and systolic material variables in the preoperative, postoperative, and virtual Coapsys models were adjusted so that model LV volume agreed with magnetic resonance imaging data. Chronic ischemic mitral regurgitation was abolished in the postoperative models. In each case, myofiber stress and pump function were calculated. RESULTS Both postoperative and virtual Coapsys models shifted end-systolic and end-diastolic pressure-volume relationships to the left. As a consequence and because chronic ischemic mitral regurgitation was reduced after Coapsys, pump function was unchanged. Coapsys decreased myofiber stress at end-diastole and end-systole in both the remote and infarct regions of the myocardium. However, knowledge of Coapsys and LV prestress was necessary for accurate calculation of LV myofiber stress, especially in the remote zone. CONCLUSIONS Coapsys decreases myofiber stress at end-diastole and end-systole. The improvement in myofiber stress may contribute to the long-term effect of Coapsys on LV remodeling.
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Affiliation(s)
- Richard Carrick
- College of Medicine of the University of Vermont, Burlington, Vermont, USA
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Yang C, Tang D, Geva T, Rathod R, Yamauchi H, Gooty V, Tang A, Gaudette G, Billiar KL, Kural MH, del Nido PJ. Using contracting band to improve right ventricle ejection fraction for patients with repaired tetralogy of Fallot: a modeling study using patient-specific CMR-based 2-layer anisotropic models of human right and left ventricles. J Thorac Cardiovasc Surg 2012; 145:285-93, 293.e1-2. [PMID: 22487437 DOI: 10.1016/j.jtcvs.2012.03.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2011] [Revised: 02/09/2012] [Accepted: 03/12/2012] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Patients with repaired tetralogy of Fallot account for most cases of late-onset right ventricle failure. The current surgical approach, which includes pulmonary valve replacement/insertion, has yielded mixed results. A new surgical option of placing an elastic band in the right ventricle is proposed to improve right ventricular cardiac function as measured by the ejection fraction. METHODS A total of 20 computational right ventricular/left ventricular/patch/band combination models using cardiac magnetic resonance imaging from a patient with tetralogy of Fallot were constructed to investigate the effect of band material stiffness variations, band length, and active contraction. These models included 4 different band material properties, 3 band length, 3 active contracting band materials, and models with patch and scar replaced by contracting tissue. RESULTS Our results indicated that the band insertion, combined with active band contraction and tissue regeneration techniques that restore right ventricular myocardium, has the potential to improve right ventricular ejection fraction by 7.5% (41.63% ejection fraction from the best active band model to more than 34.10% ejection fraction from baseline passive band model) and 4.2% (41.63% from the best active band model compared with cardiac magnetic resonance imaging-measured ejection fraction of 37.45%). CONCLUSIONS The cardiac magnetic resonance imaging-based right ventricular/left ventricular/patch/band model provides a proof of concept for using elastic bands to improve right ventricular cardiac function. Band insertion, combined with myocardium regeneration techniques and right ventricular remodeling surgical procedures, has the potential to improve ventricular function in patients with repaired tetralogy of Fallot and other similar forms of right ventricular dysfunction after surgery. Additional investigations using in vitro experiments, animal models, and, finally, patient studies are warranted.
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Affiliation(s)
- Chun Yang
- Mathematical Sciences Department, Worcester Polytechnic Institute, Worcester, Mass 01609, USA
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Perlowski A, St Goar F, Glower DG, Feldman T. Percutanenous therapies for mitral regurgitation. Curr Probl Cardiol 2012; 37:42-68. [PMID: 22230740 DOI: 10.1016/j.cpcardiol.2011.09.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Percutaneous therapies for the treatment of mitral regurgitation have emerged rapidly over the past several years. Most of the percutaneous approaches are modifications of existing surgical approaches to mitral annuloplasty or leaflet repair. Most of the percutaneous devices are based on surgical approaches. Catheter-based leaflet repair with the MitraClip is accomplished using an implantable clip to mimic the surgical edge-to-edge technique. Percutaneous annuloplasty can be achieved indirectly via the coronary sinus, or directly from retrograde left ventricular access. Several of these percutaneous approaches have been successfully used in trials or are in the early stages of use in practice.
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Durán D, Lugo J, Montoto J, Casais R. El tratamiento quirúrgico de la insuficiencia mitral isquémica. CIRUGIA CARDIOVASCULAR 2011. [DOI: 10.1016/s1134-0096(11)70050-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Mechanistic Insights into Ischemic Mitral Regurgitation: Echocardiographic and Surgical Implications. J Am Soc Echocardiogr 2011; 24:707-19. [DOI: 10.1016/j.echo.2011.04.001] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2010] [Indexed: 11/24/2022]
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Percutaneous Leaflet Repair and Annuloplasty for Mitral Regurgitation. J Am Coll Cardiol 2011; 57:529-37. [DOI: 10.1016/j.jacc.2010.10.012] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2010] [Revised: 10/20/2010] [Accepted: 10/28/2010] [Indexed: 11/17/2022]
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Grossi EA, Patel N, Woo YJ, Goldberg JD, Schwartz CF, Subramanian V, Feldman T, Bourge R, Baumgartner N, Genco C, Goldman S, Zenati M, Wolfe JA, Mishra YK, Trehan N, Mittal S, Shang S, Mortier TJ, Schweich CJ. Outcomes of the RESTOR-MV Trial (Randomized Evaluation of a Surgical Treatment for Off-Pump Repair of the Mitral Valve). J Am Coll Cardiol 2010; 56:1984-93. [DOI: 10.1016/j.jacc.2010.06.051] [Citation(s) in RCA: 103] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2009] [Revised: 04/15/2010] [Accepted: 06/16/2010] [Indexed: 11/27/2022]
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Fumoto H, Takaseya T, Shiose A, Saraiva RM, Arakawa Y, Park M, Rao S, Dessoffy R, Chen JF, Zhou Q, Calabro A, Banbury M, Fukamachi K. Mitral Annular Remodeling to Treat Functional Mitral Regurgitation: A Pilot Acute Study in a Canine Model. Heart Surg Forum 2010; 13:E247-50. [DOI: 10.1532/hsf98.20101003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Sack S, Kahlert P, Erbel R. Percutaenous mitral valve: A non-stented coronary sinus device for the treatment of functional mitral regurgitation in heart failure patients. MINIM INVASIV THER 2010; 18:156-63. [PMID: 19431068 DOI: 10.1080/13645700902951044] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Functional mitral regurgitation in heart failure limits survival in a severity-graded fashion. Even mild mitral regurgitation doubles mortality risk. We report the use of a non-stented coronary sinus device to reduce mitral annulus dimension in order to re-establish mitral valve competence. The device (PTMA, Viacor, Inc., Wilmington, MA, USA) consists of a multi-lumen PTFE (Teflon) PTMA catheter in which Nitinol (nickel-titanium alloy) treatment rods are advanced. For individual use up to three rods of different length and stiffness can be used. Therefore dimension reduction can be performed in an incremental fashion. Fluoroscopy and 3 D echocardiography are performed throughout the procedure to visiualize the positioning and confirm maximum treatment effect. The case describes the use and the effect of PTMA treatment. Safety and efficacy of the PTMA device will be investigated in the upcoming PTOLEMY 2 trial.
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Affiliation(s)
- Stefan Sack
- Department of Cardiology, Pneumology, and Internal Intensive Care Medicine, Schwabing Hospital, Academic Municipal Hospital Munich, Munich, Germany.
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First finite element model of the left ventricle with mitral valve: insights into ischemic mitral regurgitation. Ann Thorac Surg 2010; 89:1546-53. [PMID: 20417775 DOI: 10.1016/j.athoracsur.2010.02.036] [Citation(s) in RCA: 96] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2009] [Revised: 02/09/2010] [Accepted: 02/12/2010] [Indexed: 11/23/2022]
Abstract
BACKGROUND Left ventricular remodeling after posterobasal myocardial infarction can lead to ischemic mitral regurgitation. This occurs as a consequence of leaflet tethering due to posterior papillary muscle displacement. METHODS A finite element model of the left ventricle, mitral apparatus, and chordae tendineae was created from magnetic resonance images from a sheep that developed moderate mitral regurgitation after posterobasal myocardial infarction. Each region of the model was characterized by a specific constitutive law that captured the material response when subjected to physiologic pressure loading. RESULTS The model simulation produced a gap between the posterior and anterior leaflets, just above the infarcted posterior papillary muscle, which is indicative of mitral regurgitation. When the stiffness of the infarct region was reduced, this caused the wall to distend and the gap area between the leaflets to increase by 33%. Additionally, the stress in the leaflets increased around the chordal connection points near the gap. CONCLUSIONS The methodology outlined in this work will allow a finite element model of both the left ventricle and mitral valve to be generated using noninvasive techniques.
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Feldman T. Percutaneous mitral valve repair: an overview of new interventional therapies and associated outcomes. Interv Cardiol 2010. [DOI: 10.2217/ica.10.4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Sack S. [Percutaneous mitral annuloplasty with the VIACOR coronary sinus system for the treatment of functional mitral regurgitation in heart failure patients. Development and results]. Herz 2009; 34:468-76. [PMID: 19784565 DOI: 10.1007/s00059-009-3287-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Functional mitral regurgitation (MR) in heart failure patients limits survival in a severity-graded fashion. Even mild MR doubles the mortality risk. The use of a nonstented coronary sinus device to reduce mitral annulus dimension in order to reestablish mitral valve competence is reported. The device (PTMA, Viacor, Inc., Wilmington, MA, USA) consists of a multilumen PTFE (Teflon) PTMA catheter in which nitinol (nickel-titanium alloy) treatment rods are advanced. For individual treatment, up to three rods of different length and stiffness can be used. Therefore, dimension reduction can be performed in an incremental fashion. Fluoroscopy and three-dimensional (3-D) echocardiography are performed through the procedure to visualize the positioning and confirm maximum treatment effect. This report describes an implant case and summarizes the safety and feasibility of the new PTMA treatment device in 27 patients. The cases reflect the learning curve in both device design and implantation technique. In permanent implant, a sustained reduction of mitral annulus septal-lateral dimension from 3-D echo reconstruction dimensions was observed (4.9 +/- 1.2 mm at 3 months).
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Affiliation(s)
- Stefan Sack
- Klinik für Kardiologie, Pneumologie und Internistische Intensivmedizin, Klinikum Schwabing, Städtisches Klinikum München GmbH, München, Germany.
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Ruiz CE, Kronzon I. The Wishful Thinking of Indirect Mitral Annuloplasty. Circ Cardiovasc Interv 2009; 2:271-2. [DOI: 10.1161/circinterventions.109.888586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Carlos E. Ruiz
- From the Lenox Hill Heart and Vascular Institute of New York (C.E.R.) and Leon H. Charney Division of Cardiology (I.K.), New York University Medical School, New York, NY
| | - Itzhak Kronzon
- From the Lenox Hill Heart and Vascular Institute of New York (C.E.R.) and Leon H. Charney Division of Cardiology (I.K.), New York University Medical School, New York, NY
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Sack S, Kahlert P, Bilodeau L, Pièrard LA, Lancellotti P, Legrand V, Bartunek J, Vanderheyden M, Hoffmann R, Schauerte P, Shiota T, Marks DS, Erbel R, Ellis SG. Percutaneous Transvenous Mitral Annuloplasty. Circ Cardiovasc Interv 2009; 2:277-84. [PMID: 20031729 DOI: 10.1161/circinterventions.109.855205] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
We assessed the safety and feasibility of permanent implantation of a novel coronary sinus mitral repair device (PTMA, Viacor Inc).
Methods and Results—
Symptomatic (New York Heart Association class 2 or 3) patients with primarily functional mitral regurgitation (MR) were included. A diagnostic PTMA procedure was performed in the coronary sinus venous continuity. MR was assessed and the PTMA device adjusted to optimize efficacy. If MR reduction (≥1 grade) was observed, placement of a PTMA implant was attempted. Implanted patients were evaluated with echocardiographic, quality of life, and exercise capacity metrics. Nineteen patients received a diagnostic PTMA study. Diagnostic PTMA was effective in 13 patients (MR grade 3.2�0.6 reduced to 2.0�1.0), and PTMA implants were placed in 9 patients. Four devices were removed uneventfully (7, 84, 197, and 216 days), 3 for annuloplasty surgery due to observed PTMA device migration and/or diminished efficacy. No procedure or device-related major adverse events with permanent sequela were observed in any of the diagnostic or implant patients. Sustained reductions of mitral annulus septal-lateral dimension from 3D echo reconstruction dimensions were observed (4.0�1.2 mm at 3 months).
Conclusions—
Percutaneous implantation of the PTMA device is feasible and safe. Acute results demonstrate a possibly meaningful reduction of MR in responding patients. Sustained favorable geometric modification of the mitral annulus has been observed, though reduction of MR has been limited. The PTMA method warrants continued evaluation and development.
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Affiliation(s)
- Stefan Sack
- From the Department of Cardiology (S.S., P.K., R.E.), West German Heart Center, Essen, Germany; the Department of Medicine (L.B.), Montreal Heart Institute, Montréal, Canada; the Department of Cardiology (L.P., V.L., P.L.), University Hospital of Liège, Liège, Belgium; the Department of Cardiology (R.H., P.S.), R-WTH University Hospital Aachen, Aachen, Germany; the Cardiovascular Center OLV Ziekenhuis (J.B., M.V.), Aalst, Belgium; Medical College of Wisconsin (D.M.), Milwaukee, Wis; and
| | - Philipp Kahlert
- From the Department of Cardiology (S.S., P.K., R.E.), West German Heart Center, Essen, Germany; the Department of Medicine (L.B.), Montreal Heart Institute, Montréal, Canada; the Department of Cardiology (L.P., V.L., P.L.), University Hospital of Liège, Liège, Belgium; the Department of Cardiology (R.H., P.S.), R-WTH University Hospital Aachen, Aachen, Germany; the Cardiovascular Center OLV Ziekenhuis (J.B., M.V.), Aalst, Belgium; Medical College of Wisconsin (D.M.), Milwaukee, Wis; and
| | - Luc Bilodeau
- From the Department of Cardiology (S.S., P.K., R.E.), West German Heart Center, Essen, Germany; the Department of Medicine (L.B.), Montreal Heart Institute, Montréal, Canada; the Department of Cardiology (L.P., V.L., P.L.), University Hospital of Liège, Liège, Belgium; the Department of Cardiology (R.H., P.S.), R-WTH University Hospital Aachen, Aachen, Germany; the Cardiovascular Center OLV Ziekenhuis (J.B., M.V.), Aalst, Belgium; Medical College of Wisconsin (D.M.), Milwaukee, Wis; and
| | - Luc A. Pièrard
- From the Department of Cardiology (S.S., P.K., R.E.), West German Heart Center, Essen, Germany; the Department of Medicine (L.B.), Montreal Heart Institute, Montréal, Canada; the Department of Cardiology (L.P., V.L., P.L.), University Hospital of Liège, Liège, Belgium; the Department of Cardiology (R.H., P.S.), R-WTH University Hospital Aachen, Aachen, Germany; the Cardiovascular Center OLV Ziekenhuis (J.B., M.V.), Aalst, Belgium; Medical College of Wisconsin (D.M.), Milwaukee, Wis; and
| | - Patrizio Lancellotti
- From the Department of Cardiology (S.S., P.K., R.E.), West German Heart Center, Essen, Germany; the Department of Medicine (L.B.), Montreal Heart Institute, Montréal, Canada; the Department of Cardiology (L.P., V.L., P.L.), University Hospital of Liège, Liège, Belgium; the Department of Cardiology (R.H., P.S.), R-WTH University Hospital Aachen, Aachen, Germany; the Cardiovascular Center OLV Ziekenhuis (J.B., M.V.), Aalst, Belgium; Medical College of Wisconsin (D.M.), Milwaukee, Wis; and
| | - Victor Legrand
- From the Department of Cardiology (S.S., P.K., R.E.), West German Heart Center, Essen, Germany; the Department of Medicine (L.B.), Montreal Heart Institute, Montréal, Canada; the Department of Cardiology (L.P., V.L., P.L.), University Hospital of Liège, Liège, Belgium; the Department of Cardiology (R.H., P.S.), R-WTH University Hospital Aachen, Aachen, Germany; the Cardiovascular Center OLV Ziekenhuis (J.B., M.V.), Aalst, Belgium; Medical College of Wisconsin (D.M.), Milwaukee, Wis; and
| | - Jozef Bartunek
- From the Department of Cardiology (S.S., P.K., R.E.), West German Heart Center, Essen, Germany; the Department of Medicine (L.B.), Montreal Heart Institute, Montréal, Canada; the Department of Cardiology (L.P., V.L., P.L.), University Hospital of Liège, Liège, Belgium; the Department of Cardiology (R.H., P.S.), R-WTH University Hospital Aachen, Aachen, Germany; the Cardiovascular Center OLV Ziekenhuis (J.B., M.V.), Aalst, Belgium; Medical College of Wisconsin (D.M.), Milwaukee, Wis; and
| | - Marc Vanderheyden
- From the Department of Cardiology (S.S., P.K., R.E.), West German Heart Center, Essen, Germany; the Department of Medicine (L.B.), Montreal Heart Institute, Montréal, Canada; the Department of Cardiology (L.P., V.L., P.L.), University Hospital of Liège, Liège, Belgium; the Department of Cardiology (R.H., P.S.), R-WTH University Hospital Aachen, Aachen, Germany; the Cardiovascular Center OLV Ziekenhuis (J.B., M.V.), Aalst, Belgium; Medical College of Wisconsin (D.M.), Milwaukee, Wis; and
| | - Rainer Hoffmann
- From the Department of Cardiology (S.S., P.K., R.E.), West German Heart Center, Essen, Germany; the Department of Medicine (L.B.), Montreal Heart Institute, Montréal, Canada; the Department of Cardiology (L.P., V.L., P.L.), University Hospital of Liège, Liège, Belgium; the Department of Cardiology (R.H., P.S.), R-WTH University Hospital Aachen, Aachen, Germany; the Cardiovascular Center OLV Ziekenhuis (J.B., M.V.), Aalst, Belgium; Medical College of Wisconsin (D.M.), Milwaukee, Wis; and
| | - Patrick Schauerte
- From the Department of Cardiology (S.S., P.K., R.E.), West German Heart Center, Essen, Germany; the Department of Medicine (L.B.), Montreal Heart Institute, Montréal, Canada; the Department of Cardiology (L.P., V.L., P.L.), University Hospital of Liège, Liège, Belgium; the Department of Cardiology (R.H., P.S.), R-WTH University Hospital Aachen, Aachen, Germany; the Cardiovascular Center OLV Ziekenhuis (J.B., M.V.), Aalst, Belgium; Medical College of Wisconsin (D.M.), Milwaukee, Wis; and
| | - Takahiro Shiota
- From the Department of Cardiology (S.S., P.K., R.E.), West German Heart Center, Essen, Germany; the Department of Medicine (L.B.), Montreal Heart Institute, Montréal, Canada; the Department of Cardiology (L.P., V.L., P.L.), University Hospital of Liège, Liège, Belgium; the Department of Cardiology (R.H., P.S.), R-WTH University Hospital Aachen, Aachen, Germany; the Cardiovascular Center OLV Ziekenhuis (J.B., M.V.), Aalst, Belgium; Medical College of Wisconsin (D.M.), Milwaukee, Wis; and
| | - David S. Marks
- From the Department of Cardiology (S.S., P.K., R.E.), West German Heart Center, Essen, Germany; the Department of Medicine (L.B.), Montreal Heart Institute, Montréal, Canada; the Department of Cardiology (L.P., V.L., P.L.), University Hospital of Liège, Liège, Belgium; the Department of Cardiology (R.H., P.S.), R-WTH University Hospital Aachen, Aachen, Germany; the Cardiovascular Center OLV Ziekenhuis (J.B., M.V.), Aalst, Belgium; Medical College of Wisconsin (D.M.), Milwaukee, Wis; and
| | - Raimund Erbel
- From the Department of Cardiology (S.S., P.K., R.E.), West German Heart Center, Essen, Germany; the Department of Medicine (L.B.), Montreal Heart Institute, Montréal, Canada; the Department of Cardiology (L.P., V.L., P.L.), University Hospital of Liège, Liège, Belgium; the Department of Cardiology (R.H., P.S.), R-WTH University Hospital Aachen, Aachen, Germany; the Cardiovascular Center OLV Ziekenhuis (J.B., M.V.), Aalst, Belgium; Medical College of Wisconsin (D.M.), Milwaukee, Wis; and
| | - Stephen G. Ellis
- From the Department of Cardiology (S.S., P.K., R.E.), West German Heart Center, Essen, Germany; the Department of Medicine (L.B.), Montreal Heart Institute, Montréal, Canada; the Department of Cardiology (L.P., V.L., P.L.), University Hospital of Liège, Liège, Belgium; the Department of Cardiology (R.H., P.S.), R-WTH University Hospital Aachen, Aachen, Germany; the Cardiovascular Center OLV Ziekenhuis (J.B., M.V.), Aalst, Belgium; Medical College of Wisconsin (D.M.), Milwaukee, Wis; and
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Abstract
Mitral annuloplasty is the most common surgical procedure performed for mitral valve regurgitation, whether performed alone or as part of a more complex repair. A less invasive percutaneous approach to mitral annuloplasty associated with lesser morbidity might offer advantages over a surgical procedure in some patients, even if less efficacious. We review current experimental percutaneous approaches to mitral annuloplasty.
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Affiliation(s)
- Jean-Bernard Masson
- From the St Paul’s Hospital, University of British Columbia, Vancouver, Canada
| | - John G. Webb
- From the St Paul’s Hospital, University of British Columbia, Vancouver, Canada
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Simon MA, Watson J, Baldwin JT, Wagner WR, Borovetz HS. Current and Future Considerations in the Use of Mechanical Circulatory Support Devices. Annu Rev Biomed Eng 2008; 10:59-84. [DOI: 10.1146/annurev.bioeng.9.060906.151856] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Marc A. Simon
- Cardiovascular Institute, University of Pittsburgh, Pittsburgh, Pennsylvania 15213;
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania 15213
| | - John Watson
- Department of Bioengineering, University of California, San Diego, La Jolla, California, 92093
| | | | - William R. Wagner
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania 15213
- Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania 15213
- Department of Chemical Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania 15213
| | - Harvey S. Borovetz
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania 15213
- Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania 15213
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Abstract
Ischemic cardiomyopathy affects an estimated 3 million people in the USA and is the most common cause of heart failure. Traditional operations have included heart transplantation, myocardial revascularization, mitral valve repair, left ventricular reconstruction, first-generation left ventricular assist devices and cardiac resynchronization therapy. These operations have become safer in recent times, due to improved technologies. Current technologies and surgical approaches can benefit a significant number of patients. However, there remains a large group of patients in whom traditional approaches can not be offered. Newer generation ventricular assist devices, passive ventricular restraint devices and cellular-based therapies (including skeletal- and bone marrow-derived stem cells) have the potential to be more universal in their applications. Ongoing investigations with each of these modalities will allow surgeons to offer treatment to patients who are not considered surgical candidates at this time.
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Affiliation(s)
- Gorav Ailawadi
- TCV Surgery, PO Box 800679, Charlottesville, VA 22908, USA.
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Percutaneous and off-pump treatments for functional mitral regurgitation. J Artif Organs 2008; 11:12-8. [DOI: 10.1007/s10047-007-0399-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2007] [Indexed: 10/22/2022]
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Affiliation(s)
- Paul W.M. Fedak
- From Libin Cardiovascular Institute of Alberta (P.W.M.F.), Division of Cardiac Surgery, Department of Cardiac Sciences, University of Calgary, Calgary, Alberta, Canada; and Bluhm Cardiovascular Institute, Division of Cardiothoracic Surgery (P.M.M.) and Division of Cardiology (R.O.B.), Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Patrick M. McCarthy
- From Libin Cardiovascular Institute of Alberta (P.W.M.F.), Division of Cardiac Surgery, Department of Cardiac Sciences, University of Calgary, Calgary, Alberta, Canada; and Bluhm Cardiovascular Institute, Division of Cardiothoracic Surgery (P.M.M.) and Division of Cardiology (R.O.B.), Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Robert O. Bonow
- From Libin Cardiovascular Institute of Alberta (P.W.M.F.), Division of Cardiac Surgery, Department of Cardiac Sciences, University of Calgary, Calgary, Alberta, Canada; and Bluhm Cardiovascular Institute, Division of Cardiothoracic Surgery (P.M.M.) and Division of Cardiology (R.O.B.), Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, Ill
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Filsoufi F, Rahmanian PB, Anyanwu A, Adams DH. Physiologic Basis for the Surgical Treatment of Ischemic Mitral Regurgitation. ACTA ACUST UNITED AC 2006; 4:261-8. [PMID: 17086006 DOI: 10.1111/j.1541-9215.2006.05932.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Ischemic mitral regurgitation (MR) can complicate severe coronary artery disease and myocardial infarction. Ischemic MR results from left ventricular remodeling after myocardial infarction and can also accompany acute myocardial ischemia. The most common mechanism of ischemic MR is Carpentier's type IIIb dysfunction due to an apical and lateral displacement of papillary muscles leading to a tethering of the mitral leaflets. This apical tenting of the leaflets prevents the free margin from reaching the plane of the annulus, significantly reduces the surface of coaptation, and causes MR. Recent advances in imaging studies have led to a better understanding of the pathophysiology of this condition as well as to the development of innovative surgical approaches to treat this disease. Current research efforts have mainly focused on 2 directions: (1) percutaneous approaches to correct MR, and (2) surgical therapy to address the ventricular component of the disease. In this article, the authors define ischemic MR and review its pathophysiology, current management strategies, and future directions.
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Affiliation(s)
- Farzan Filsoufi
- Department of Cardiothoracic Surgery, Mount Sinai School of Medicine, New York, NY 10029, USA.
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Woo YJ, Rodriguez E, Atluri P, Chitwood WR. Minimally Invasive, Robotic, and Off-Pump Mitral Valve Surgery. Semin Thorac Cardiovasc Surg 2006; 18:139-47. [PMID: 17157235 DOI: 10.1053/j.semtcvs.2006.07.004] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/21/2006] [Indexed: 11/11/2022]
Abstract
A significant transformation is occurring in the management of mitral valve disease. Earlier surgery is now recommended. Mitral valve repair is the standard of care, and newer methods of reconstructing the mitral valve are developing. Surgery with videoscopic assistance can be effectively performed without sternotomy. Robotics systems are gaining wider adoption. Implantable devices to repair or replace the mitral valve off-pump and percutaneously are emerging.
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Affiliation(s)
- Y Joseph Woo
- Division of Cardiothoracic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA 19104, USA.
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Hjelmqvist L, Norin A, El-Ahmad M, Griffiths W, Jörnvall H. Distinct but parallel evolutionary patterns between alcohol and aldehyde dehydrogenases: addition of fish/human betaine aldehyde dehydrogenase divergence. Cell Mol Life Sci 2003; 60:2009-16. [PMID: 14523561 DOI: 10.1007/s00018-003-3287-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Alcohol dehydrogenases (ADHs) of the MDR type (medium-chain dehydrogenases/reductases) have diverged into two evolutionary groups in eukaryotes: a set of 'constant' enzymes (class III) typical of basal enzymes, and a set of 'variable' enzymes (remaining classes) suggesting 'evolving' forms. The variable set has larger overall variability, different segment variability, and variability also in functional segments. Using a major aldehyde dehydrogenase (ALDH) from cod liver and fish ALDHs deduced from the draft genome sequence of Fugu rubripes (Japanese puffer fish), we found that ALDHs form more complex patterns than the ADHs. Nevertheless, ALDHs also group into 'constant' and 'variable' sets, have separate segment variabilities, and distinct functions. Betaine ALDH (class 9 ALDH) is 'constant,' has three segments of variability, all non-functional, and a limited fish/human divergence, reminiscent of the ADH class III pattern. Enzymatic properties of fish betaine ALDH were also determined. Although all ALDH patterns are still not known, overall patterns are related to those of ADH, and group separations may be distinguished. The results can be interpreted functionally, support ALDH isozyme distinctions, and assign properties to the multiplicities of the ADH and ALDH enzymes.
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Affiliation(s)
- L Hjelmqvist
- Department of Medical Biochemistry and Biophysics, Karolinska Institutet, 17177 Stockholm, Sweden
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