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Percutaneous transvenous mitral annuloplasty: initial human experience with a novel coronary sinus implant device. Circ Cardiovasc Interv 2009 Aug;2(4):277-84

Date

12/25/2009

Pubmed ID

20031729

DOI

10.1161/CIRCINTERVENTIONS.109.855205

Scopus ID

2-s2.0-70349722160   100 Citations

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 (> or =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.

Author List

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

Author

David S. Marks MD Vice Chair, Professor in the Medicine department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Aged
Canada
Cardiac Catheterization
Coronary Sinus
Device Removal
Echocardiography, Three-Dimensional
Echocardiography, Transesophageal
Europe
Exercise Tolerance
Feasibility Studies
Female
Heart Valve Prosthesis
Heart Valve Prosthesis Implantation
Humans
Male
Middle Aged
Mitral Valve
Mitral Valve Insufficiency
Pilot Projects
Prosthesis Design
Prosthesis Failure
Quality of Life
Recovery of Function
Severity of Illness Index
Time Factors
Treatment Outcome