Eric N Feins1, Haruo Yamauchi1, Gerald R Marx2, Franz P Freudenthal3, Hua Liu1, Pedro J Del Nido1, Nikolay V Vasilyev4. 1. Department of Cardiac Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Mass. 2. Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, Mass. 3. Department of Pediatric Cardiology, Kardiozentrum, La Paz, Bolivia. 4. Department of Cardiac Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Mass. Electronic address: nikolay.vasilyev@childrens.harvard.edu.
Abstract
OBJECTIVE: Recently, there has been increased interest in minimally invasive mitral valve prolapse repair techniques; however, these techniques have limitations. A new technique was developed for treating mitral valve prolapse that uses a novel leaflet plication clip to selectively plicate the prolapsed leaflet segment. The clip's efficacy was tested in an animal model. METHODS: Yorkshire pigs (n = 7) were placed on cardiopulmonary bypass (CPB), and mitral valve prolapse was created by cutting chordae supporting the P2 segment of the posterior leaflet. Animals were weaned off CPB and mitral regurgitation (MR) was assessed echocardiographically. CPB was reinitiated and the plication clip was applied under direct vision to the P2 segment to eliminate the prolapse. The animals survived for 2 hours. Epicardial echocardiography was obtained before and after prolapse creation and 2 hours after clip placement to quantify MR grade and vena contracta area. Posterior leaflet mobility and coaptation height were analyzed before and after clip placement. RESULTS: There were no cases of clip embolization. Median MR grade increased from trivial (0-1.5) to moderate-severe after MR creation (2.5-4+) (P < .05), and decreased to mild after clip placement (0-3+) (P < .05). Vena contracta area tended to increase after cutting the chordae and decrease after clip placement: 0.08 ± 0.10 cm(2) versus 0.21 ± 0.15 cm(2) versus 0.16 ± 0.16 cm(2) (P = .21). The plication clip did not impair leaflet mobility. Coaptation height was restored to baseline: 0.51 ± 0.07 cm versus 0.44 ± 0.18 cm (P = 1.0). CONCLUSIONS: The leaflet plication clip can treat mitral valve prolapse in an animal model, restoring coaptation height without affecting leaflet mobility. This approach is a simple technique that may improve the effectiveness of beating-heart and minimally invasive valve surgery.
OBJECTIVE: Recently, there has been increased interest in minimally invasive mitral valve prolapse repair techniques; however, these techniques have limitations. A new technique was developed for treating mitral valve prolapse that uses a novel leaflet plication clip to selectively plicate the prolapsed leaflet segment. The clip's efficacy was tested in an animal model. METHODS: Yorkshire pigs (n = 7) were placed on cardiopulmonary bypass (CPB), and mitral valve prolapse was created by cutting chordae supporting the P2 segment of the posterior leaflet. Animals were weaned off CPB and mitral regurgitation (MR) was assessed echocardiographically. CPB was reinitiated and the plication clip was applied under direct vision to the P2 segment to eliminate the prolapse. The animals survived for 2 hours. Epicardial echocardiography was obtained before and after prolapse creation and 2 hours after clip placement to quantify MR grade and vena contracta area. Posterior leaflet mobility and coaptation height were analyzed before and after clip placement. RESULTS: There were no cases of clip embolization. Median MR grade increased from trivial (0-1.5) to moderate-severe after MR creation (2.5-4+) (P < .05), and decreased to mild after clip placement (0-3+) (P < .05). Vena contracta area tended to increase after cutting the chordae and decrease after clip placement: 0.08 ± 0.10 cm(2) versus 0.21 ± 0.15 cm(2) versus 0.16 ± 0.16 cm(2) (P = .21). The plication clip did not impair leaflet mobility. Coaptation height was restored to baseline: 0.51 ± 0.07 cm versus 0.44 ± 0.18 cm (P = 1.0). CONCLUSIONS: The leaflet plication clip can treat mitral valve prolapse in an animal model, restoring coaptation height without affecting leaflet mobility. This approach is a simple technique that may improve the effectiveness of beating-heart and minimally invasive valve surgery.
Authors: Antonio M Calafiore; Michele Di Mauro; Guglielmo Actis-Dato; Angela Lorena Iacò; Paolo Centofanti; Piero Forsennati; Francesco Patanè; Lorena Di Gioacchino Journal: Ann Thorac Surg Date: 2006-05 Impact factor: 4.330
Authors: Philipp Kahlert; Björn Plicht; Ingmar M Schenk; Rolf-Alexander Janosi; Raimund Erbel; Thomas Buck Journal: J Am Soc Echocardiogr Date: 2008-04-02 Impact factor: 5.251
Authors: Mariana Mirabel; Bernard Iung; Gabriel Baron; David Messika-Zeitoun; Delphine Détaint; Jean-Louis Vanoverschelde; Eric G Butchart; Philippe Ravaud; Alec Vahanian Journal: Eur Heart J Date: 2007-03-09 Impact factor: 29.983
Authors: A M Gillinov; D M Cosgrove; E H Blackstone; R Diaz; J H Arnold; B W Lytle; N G Smedira; J F Sabik; P M McCarthy; F D Loop Journal: J Thorac Cardiovasc Surg Date: 1998-11 Impact factor: 5.209
Authors: Isaac Wamala; Mossab Y Saeed; Peter E Hammer; Daniel Bautista-Salinas; Kimberlee Gauvreau; Sunil J Ghelani; Nikolay V Vasilyev; Pedro J Del Nido Journal: Interact Cardiovasc Thorac Surg Date: 2021-08-12